External and iatrogenic traumas of urinary bladder managed in urologicai departments
in poland between 1995-199
Article published in Urologia Polska 2002/55/2.
Zygmunt F. Dobrowolski 1, Wacław Lipczyński 1, Jacek Kusionowicz 1, Piotr Jakubik 1, Barbara Dobrowolska 1, Leszek Brongel 2
- 1 Katedra i Klinika Urologii Collegium Medicum UJ w Krakowie Kierownik kliniki: prof, dr hab. Zygmunt F. Dobrowolski
2 II Katedra Chirurgii Ogólnej Collegium Medicum UJ w Krakowie Kierownik katedry: prof, dr hab. Danuta Karcz
urinary bladder, injuries
- Introduction. Urinary bladder injuries accompany most often pelvis trauma and are evoked by iatrogenic trauma.
- Material and method. The results of questionnaire, received from 61 urological departments, concerned with urinary bladder injuries treated between the years 1995-1999, were analysed.
- Results. During the 5 year period 512 patients with urinary bladder trauma injuries were noted. In 210 (41,0%) patients the injury was caused by traffic accidents, 8 (1,6%) patients were buried or squashed within the limits of pelvic bones, in 40 (7,8%) patients the cause was fall from bights, in 251 (49%) was noted the injury of iatrogenic origin and in 3 patients (0,6%) gunshot wound. Among 261 non-iatrogenic urinary bladder injuries, 41 (15,8%) were connected with pelvic bones trauma. In 36 patients were noted simultaneous injury of urinary bladder and urethra posterior which constitute 13,7% of such injuries and
- 7% of all trauma cases. The injuries of iatrogenic origin occurred in 98 patients (39%) at urological department, in 130 (51,8%) women at gynecological department and in 23 patients (9,2%) at surgical ward. There was open injury in 102 patients (20,0%) and the closed in 372 (72,6%). Urinary bladder contusion was noted in 38 patients (7,4%). Intraperitoneal injuries constituted 44,0% (225 patients) and extraperitoneal 56,0% (287 patients). During the diagnostics there were performed 455 (88,8%) ultrasonographies of abdominal cavity, 266 (51,9%) 1VR 388 (75,7%) cystographies and 15 (2,9%) CT scans. The period of time from the moment the trauma occurred to diagnosis varied from 0,5 to 124 hours. During the surgical treatment of injury, the monolayer suture of urinary bladder wall was performed in 51 patients (10%), two-layered suture in 461 patients (90%), perivesical drainage was applied in 468 (91,4%) patients and peritoneal cavity checking in 232 (45,3%) patients. The time of treatment varied from 7 to 70 days, 14 days on average. The treatment failed with decease in 7 persons (1,4%). Conclusions. In presented material it was large percentage 49,0% (251 patients) of iatrogenic injuries and among them 51,8% occurred at gynecologic and maternity wards. For that reason it is necessarily to leach the basic range of urological operations to young doctors. The most often applied diagnostic method wasn\'t ascending cystography but ultrasonography. We recommend ascending cystography to perform it in at least two projections after filling urinary bladder with about 300ml of contrast medium and additional X-ray radiogram after emptying the contrast out of urinary bladder. In patients with pelvic bone trauma it is reasonable to perform spiral CT with virtual analysis, which would precede surgery. We suggest two-layered sutures of urinary bladder wall with perivesical drainage.
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