5. TRAUMATIC UROLOGICAL EMERGENCIES 107
These are often much larger than is suggested by cystography and for this reason are less likely to close spontaneously than are extraperitoneal perforations. A single or two-layered repair is performed with absorbable suture material such as 2/0 Vicryl. An intraperitoneal, perivesical drain should be placed and removed as soon as it has stopped draining significant amounts of urine. A suprapubic or urethral catheter may be used to drain the bladder (Volpe et al. 1999).
Bladder Injury During Caesarean Section
During emergency caesarean section, in the desperate rush to deliver the baby safely, the bladder may be injured. This problem can be avoided by catheterising the bladder to deflate it, and so 'moving' it out of the way of the line of incision in the uterus, but despite this precaution, the bladder is from time to time injured during this procedure. The injury is usually immediately apparent and can be repaired straight away. It may have involved both the anterior and posterior walls of the bladder.
Spontaneous Rupture After Bladder Augmentation
Bladder augmentation, performed either by using a patch of intestine or stomach sutured into the bivalved bladder or by removing a disc of muscle from the dome of the bladder (detru-sor myectomy), is most often carried out in patients with neuropathic bladder problems. It is designed to convert the poorly compliant, low-volume bladder into a compliant, high-volume reservoir, thereby improving continence and in those cases with associated hydronephrosis, protecting renal function.
Spontaneous bladder rupture has been reported in approximately 5% to 10% of patients after bladder augmentation (DeFoor et al. 2003). Its occurrence is by no means limited to the first few week or months after augmentation. Indeed, it may occur many years after augmentation. Ileocystoplasties are probably more likely to rupture than are gastrocystoplasties (DeFoor et al. 2003, Shekarriz et al. 2000).