Login to Access Video or Poster Abstract: MP79-10
Sources of Funding: None

Introduction

Non-operative management of uncomplicated traumatic extraperitoneal (EP) bladder ruptures has become the standard of care. However, a number of these patients still develop significant complications. We sought to evaluate our experience with urinary-cutaneous fistulae (UCF) in conservatively managed EP rupture patients.

Methods

Review of our institutional trauma registry identified all patients admitted with blunt-trauma EP bladder ruptures from 2000 to 2014. Patients with concomitant urethral, bladder neck, or ureteral injuries were excluded. All patients who underwent primary management with catheter drainage alone were included in the analysis. Patient characteristics, urologic complications (specifically UCF) and management strategies were evaluated.

Results

162 traumatic bladder injuries were identified during the study period. 96/162 (59%) of these bladder injuries were classified as EP. 56/96 (58%) of EP ruptures were managed conservatively with catheter drainage, of which 10 (18%) developed major urologic complications (Clavien Dindo-Grade ≥ III), with 6/10 (60%) developing UCF (6/56 [11%]). Of the patients with UCF, mean age was 47.9 years with 50% of patients female. All injuries were a result of motor vehicle accidents, with a mean injury severity score at presentation of 43.7. Four patients (66.7%) underwent non-urologic operations without cystorrhaphy at presentation, while one was taken to the operating room for cystoscopy and catheter placement alone. Mean time to diagnosis of EP rupture was three days, while mean time to diagnosis of UCF was 13.5 days. Two patients developed UCF to the perineum, while four were to the medial aspect of the thigh. One patient died without resolution of her fistula. Of the remaining five, all subsequently required operative repair for fistula resolution, with none healing spontaneously. Mean time to repair from diagnosis was 30 days (range 2 to 106). One patient required a second operation after fistula recurrence. Mean time to resolution from initial diagnosis for all patients was 90 days. _x000D_

Conclusions

UCF are an underreported but significantly morbid complication of non-operative management of EP bladder ruptures. Though our numbers preclude the ability to analyze specific predictors of UCF, the occurrence of UCF following non-operative management of EP bladder rupture should prompt surgical intervention given the potential for prolonged convalescence and low likelihood of spontaneous resolution.

Funding

None