Penetrating bladder injuries mandate surgical exploration to assess for other intraabdominal injuries and to determine if there is damage to the ureters or trigone.

To explore injuries, the bladder should be exposed through a midline abdominal incision and opened at the dome. This precaution minimizes the risk of incising a pelvic hematoma, which can cause brisk, difficult-to-control bleeding. All tears should be repaired from within the bladder. The bladder neck and ureteral orifices should be inspected for possible damage. Bladder neck injuries must be surgically repaired or patients may experience stress urinary incontinence. Injuries to the ureteral orifices require ureter reimplantation. After formal bladder repair, the urine is diverted using a large-bore Foley catheter and/or suprapubic tube.