Breaks and injuries of the bladder: surgery, treatment, symptoms
The bladder is an important tool of the urinary system. Rupture of the bladder is rare, as the bones of pelvis protect it. This is a severe injury, which is possible by direct penetration or blunt injury. Without timely treatment may develop additional pathological processes. Can a burst bladder in a man just so in which cases this happens and what to do?
Classification of injuries of the bladder
Bladder — an empty tank for accumulation of urine after the filtering process by the kidneys. In the unfilled state, he’s well-protected pelvic bone, and filled to the top acts in the deepening of the abdomen and becomes vulnerable. The pelvis of the child is not completely developed, so the baby on more frequently exposed to risk of injury.
Types of injuries
Injuries of the bladder are divided into two types:
- Open. In this type violates the integrity of the skin and is contact of internal organs with the external environment.
- Closed. The integrity of the skin is not broken.
Forms of injuries
Extraperitoneal and intraperitoneal injury
There are different injuries of the bladder. They are classified by site of lesion, magnitude of injury and mechanism of origin. Mostly injuries of the bladder are divided into two types:
- The ratio of the peritoneum. The area in which are situated the internal abdominal organs, called the peritoneal cavity. Damage to the bladder relative to the peritoneum are divided into:
- Extraperitoneal rupture. Such a breakthrough is a consequence of damage to the pelvic bones. Most extraperitoneal bladder ruptures can sometimes be in front or side wall, which is not covered by peritoneum. The bladder as a result of the breakthrough, is emptied completely or it remains a small part of urine. Urine flows not to the region of the peritoneum, and soft tissue surrounding the injured organ.
- Intraperitoneal rupture. Direct impact on the region of the stomach causes injury to the upper rear walls of the organ, which is poorly expressed layers of the muscles. In this period the body is associated with a thin wall, lining the space of the peritoneum, which includes the liver, spleen, intestines. As a result of injury sheath of the peritoneum also is torn, there is intraperitoneal rupture of the wall.
- The combined gap. Mixed rupture of the bladder occurs in case of serious injuries of the bones of the pelvis. The bladder is injured in a crowded condition. The gap walls can be observed in several areas in which there is a close connection with the area of the peritoneum and the pelvic region. Urine enters not only in the peritoneal cavity, but also in the pelvic area.
Partial and complete rupture
According to severity. Any injury of the bladder is characterized by a different level of severity. Students must assess the extent of damage to calculate the risk of complications. There are the following types:
Bruised body. One of the types of closed injuries. Typically, when the injury to the integrity of the shell is not disturbed and the great danger to human health no. Appears hematoma, therefore there is a need to take the clots with a catheter with a large lumen. As soon as the urine color will correspond to the normal and the doctor will confirm the presence of the catheter is optional, it will be removed.
- A partial tear of the sheath.
- A complete rupture.
In addition, the damage may affect other internal organs. In relation to the authorities injuries are divided into:
- isolated (only injured the bladder);
- combined (trauma accompanied with the injury of other organs).
The causes and mechanisms of damage
As already known, most of the damage to the bladder arise as a result of injuries. Being in the deepening of the pelvic area, protected on all sides. If it is filled with urine, it can be easily damaged, but if the «tank» is empty, you will need a sufficient strong force, or a penetrating wound of the bladder, in violation of the surface of the shell. Factors influencing damage to the bladder, are different, but among them there are the most common:
- Adverse jump, due to which you can get bladder damage during its complete fullness.
- In the drop down (especially on a hard plane) is broken not only on the excretory system, damaged many internal systems.
- Intentional infliction of wounds a firearm or knife causes injury directly to the area of the authority.
- A simple kick, push or kick in the abdomen can cause damage to the integrity of the shell.
- Damage during medical procedures:
- the installation of a catheter to drain urine;
- the expansion of urination;
- surgery on the pelvic organs.
- Delayed emptying under the influence of alcohol.
- Pathological condition in the body that cause damage:
- tumors of the pelvic organs or to them nearby organs;
- the growth of the prostate tissue;
- compression of the urethra.
Symptoms of injuries
Closed injuries do not have typical symptoms of the clinical picture. Shock dulls all sensations and the patient begins to feel pain in the abdomen soon after some time. Neither abdominal pain nor shock are not the main indicators of the gap, the result of an impact injury to nearby internal organs.
In addition to pain, symptoms of trauma is:
- violation of urination (difficulty when you attempt to go to the toilet);
- the presence of blood in the urine;
- if the damage to the urethra frequent urge to urinate;
- leakage of urine into the abdominal cavity (degloving injury);
- bright symptoms internal bleeding:
- low pressure;
- rapid beating of the pulse;
- pale skin.
- intra-abdominal injury is characterized by the symptoms of peritonitis:
- sharp pain;
- the supine position increases the pain;
- body temperature rises;
- the abdominal muscles are tense.
- extraperitoneal injury is different:
- swelling of the inguinal region, pubis;
- hematoma in the abdomen.
Damage the integrity of the shell body is in the injury of the pelvis. Therefore, together with the above symptoms, there are signs of fractures. The main task of the doctor in the presence of fractures is to ascertain the presence of damage to the bladder and urethra.
The gap, its consequences
The situation in which the doctor has to deal with exploding body requires high professionalism. What will happen if the burst bladder? For further developments affected the complexity of the injury, but the probability of developing complications:
- Severe bleeding, shock, low blood pressure, rapid pulse. The result of this condition can be death.
- The development of infection due to penetration of toxins into the blood and microorganisms, after you break the shell.
- The inflammatory process in the area of damage and blood.
- If prolonged inflammation ruptured ulcer, violated the integrity of the skin. There is a channel through which microorganisms from the environment have access to the internal organs.
- Inflammation of the lining and the internal organs of the abdominal cavity.
- Infectious inflammatory process of the bone tissue of the pelvis.
Timely diagnosis allows you to have landed on, or were the muscles, to determine the direction of further treatment. Correct diagnosis established by the physician, based on medical history, inspection data and results of diagnostic methods:
- In the first stage of diagnostic procedures necessary to conduct radiography in the determination of the integrity of the shell and identify the traumatic elements in the abdominal cavity.
- The General analysis of urine and blood to determine the presence and extent of bleeding.
- Excretory urography — a method of diagnosing urinary tract using radiopaque substances. Allows you to identify the nature of the damage.
- Ultrasound of the abdomen and zabrusky cavities allows to detect the torn sheath or the presence of internal hematomas.
- Meccinna cystography — the introduction of a catheter and contrast radiography. Procedure is necessary to confirm the gap. If the body was torn, the contrast will leak into the pelvic region.
- Computed tomography provides results with greater accuracy than ultrasonography and radiography.
- Fistulografiya — filling of the wound channel antiseptic. Used with open abdominal injuries.
The main objective in the bladder injury is as soon as possible deliver the victim to the hospital, where a surgical hospital. First aid in case of injury of the bladder is to hold management of shock, stopping bleeding. They are, according to the following procedure:
- Treat area antiseptic and bandage.
- The victim lay on his back, legs in the «frog» placed under the knee cushion, the head is raised. If the victim is in severe shock, the body should be placed at an angle of 45 degrees, lifting the legs and pelvis above the head.
- To make the stomach cold.
- Tuck the body of the patient.
- If it is possible to enter medicine, which provides blood clotting.
In closed form damage do not give pain-relieving medications.
Treatment of injuries
Each case of bladder injury requires a thorough examination in the specialized hospital and the appointment of individual therapy. The method of treatment depends on the cause that triggered the trauma, the General physical condition of the patient and the neglect of the situation. Treatment can be conservative or operative.
Held with non-serious injuries: bruises, minor extraperitoneal breaking the shell. Therapy use:
- The urethral catheter. Is installed in the bladder for a few days.
- Strict compliance with bed rest.
- Assigned to medication:
- suppress the growth of pathogenic microorganisms;
- stopping the blood;
- relieves inflammation;
Any traumatic rupture needs surgical intervention, or which does not allow the body to fully break with a slight defect, or requires a full removal. Operations are conducted through cut the skin or the keyhole way, when a neat little slit to put the instruments and camera for surveillance:
- to close the gap;
- installation of drainage (tubes) that improves the flow of urine and blood;
- cytostome used in the treatment of men and is placing a rubber tube through a duct directly deducing urine in the bladder.
The prevention of the disease
Effective preventive methods to help avoid injury on mochevyvodjashie system does not exist, in force beyond human reason, resulting in injury. But every person is capable of self-care to avoid dangerous situations and to worry about personal safety:
- Monitoring of the health and timely treatment to the doctor. Men — prostate control for women — regular checkups by a gynecologist and monitored after delivery.
- Avoidance of traumatic situations.
- Exception of alcoholic beverages.
- Regular monitoring by a specialist after the injury for 3 years.
It is important to monitor prostatic specific substance. Special antigen is a protein that monitors the prostate gland. Abnormalities detected in the tests, talking about the problems with the work or the possible development of tumors. Timely diagnosis and treatment gives a favourable outcome for health.