PRESENTATION AND DIAGNOSIS

Hematuria is a nearly universal feature of bladder rupture. Other signs include suprapubic tenderness, lower abdominal bruising, and low urine output. On laboratory assessment, patients may be found to have elevated serum creatinine concentration, acidosis, hyperkalemia, and azotemia secondary to reabsorption of extravasated urine. Women should receive a careful pelvic examination to assess for possible vaginal injuries, which can result in vesicovaginal fistulae. In addition, patients should be assessed for urethral injuries, which can lead to difficulty with voiding.

After blunt trauma, an absolute indication for imaging the bladder is the combination of pelvic fracture and gross hematuria. Relative indications include gross hematuria without pelvic fracture, as well as microhematuria with or without pelvic fracture, occurring with any of the following: the clinical signs and symptoms listed previously, free intraperitoneal fluid on abdominal imaging, or known prior bladder abnormality.