Is there a difference in outcome when treating traumatic intraperitoneal bladder rupture with or without a suprapubic tube?

Purpose: Primary bladder repair with a suprapubic tube is considered to be effective for managing intraperitoneal bladder injury. We compared the outc omes of suprapubic tube placement and no suprapubic tube for this injury. Materials and Methods: We reviewed the charts of 31 men and 3 women with a mean age of 28.5 years who required emergency operative repair without a cy stogram of traumatic bladder injury from 1992 to 1997. Patient characterist ics, mechanism of injury, associated injuries, and short and long-term comp lications were reviewed. Results: Penetrating and blunt trauma occurred in 28 (82%) and 5 (15%) pati ents, respectively, while 1 had spontaneous bladder rupture. After primary bladder repair the bladder was drained with a suprapubic tube in 18 cases ( 53%) and a urethral catheter only in 16 (47%). There were no significant di fferences between the 2 groups with respect to mechanism of injury, patient age, location of injury in the bladder, coexisting medical illnesses, stab ility in the field or emergency room, or the bladder repair technique. The 18 patients treated with a suprapubic tube had an associated injury that re sulted in 2 deaths, while 13 of the 16 treated with urethral catheter drain age only had an associated injury and 1 died. Urological and nonurological complications in the suprapubic tube versus urethral catheter only group de veloped in 28 and 33 versus 19 and 19% of the cases, respectively (p < 0.05 ). Followup ranged from 1 month to 4 years. No significant long-term morbid ity was noted in either group. Conclusions: These data indicate that intraperitoneal bladder injuries may be equally well managed by primary bladder repair and urethral catheter dra inage only versus suprapubic tube drainage.