MORBIDITY ASSOCIATED WITH NONOPERATIVE MANAGEMENT OF EXTRAPERITONEAL BLADDER INJURIES

Foley catheter drainage alone has become routine management for extrap eritoneal bladder ruptures In many medical centers, and few reports ad dress treatment failures with this approach. Over the last 10 years, 7 0 patients with bladder ruptures were managed at our institution, Thir ty-six of these had extraperitoneal injuries caused by blunt trauma, a nd 29 of these were treated by catheter drainage alone. Of those patie nts managed nonoperatively, 74% had spontaneous healing within 10 to 1 4 days; however, 26% had significant complications, including delayed healing, vesicocutaneous fistula, septic events, bladder calculi, or d eath, Although our results confirm previous reports in the literature that most patients with extraperitoneal bladder ruptures do well with nonoperative management, they also point out that a significant subset of patients do not. We were unable to identify presenting features th at would predict an unfavorable outcome, although patients with multip le pelvic fractures seem to be at high risk. The maintenance of adequa te catheter drainage and use of antibiotic prophylaxis seems to have a significant impact on outcome.