The most important causes of bladder damage

In daily life, some bad living habits may cause bladder damage. The most direct injury is direct violence. For example, it is usually attacked by external force, injured by hard objects, or kicked or punched, which directly acts on the bladder. This causes the greatest damage to the bladder and is actually indirect violence. In addition, iatrogenic bladder injury is also relatively common.

The most important causes of bladder damage

1. Direct violence (15%):

Most of the time when the bladder is inflated, the bladder is higher than the pubic bone, and direct violent action is applied to the lower abdomen, causing bladder injury, such as kicking, boxing, collision, etc. Because when the bladder is full, external force acts on the bladder equally and is transmitted to all parts. According to fluid mechanics, it acts on the weakest part of the bladder, mostly the top of the bladder covered by the peritoneum, and ruptures. The rupture here is mostly intraperitoneal bladder rupture, and urine flows into the abdominal cavity, forming urinary peritonitis, and the patient has severe and unbearable abdominal pain. We once encountered a patient with urinary retention. After catheterization, he felt that the urine flow was too slow, so he massaged and applied pressure on the pubic bone with his hands. The patient suddenly felt severe abdominal pain and the originally inflated bladder suddenly disappeared. Surgery confirmed that the top of the bladder was ruptured and urine flowed into the abdominal cavity.

It often occurs in pelvic fractures, accounting for about 80%. Sometimes it is a complex injury and may be combined with other organ injuries, such as traffic accidents, earthquakes, car accidents, falls from heights, crush injuries, combat injuries, work-related injuries, etc. In the case of pelvic fractures, the fracture ends or free bone fragments pierce the bladder. At this time, the bladder injury is mostly extraperitoneal bladder rupture, and the rupture site is mostly at the bottom of the bladder. There are also cases of posterior urethral rupture or abdominal organs, vascular damage, pelvic comminuted fractures, urine extravasation, severe blood loss, shock and other manifestations. There may also be intraperitoneal and extraperitoneal bladder ruptures (mixed, complex injuries), and the injuries are very serious. For example, a patient fell from a tractor, causing fractures of the pubic ramus and sciatic ramus, resulting in rupture of the anterior bladder wall and urine extravasation. After rescue, bladder repair, and urine extravasation drainage, the patient recovered smoothly and was discharged from the hospital after recovery. Usually, bladder injuries are most often caused by indirect violence.

3. Trauma (8%)

Firearm and sharp weapon injuries mostly occur during wars and fights, often resulting in open bladder injuries, which may also be complicated by injuries to other organs.

4. Iatrogenic bladder injury (6%):

Due to the examination of the bladder in recent years, various instrument operations such as cystoscopy, intravesical lithotripsy, various transurethral operations and treatments in the bladder, such as electrocautery and electroresection, can cause bladder perforation. Most of the time, cystoscopy is required due to bladder lesions. Some indications are not properly grasped. For example, if the bladder capacity is too small, bladder perforation may occur when the cystoscope is inserted.