Diagnostic studies in bladder rupture. Indications and techniques.

After external trauma, the patient with bladder injury usually complains of lower abdominal pain and tenderness, and macroscopic or microscopic hematuria is usually present. Simultaneous bladder and posterior urethral rupture can occur in male patients, and the diagnosis of both ruptures is rarely made preoperatively. A delayed presentation with an acute abdomen, absence of voiding, and elevated blood urea nitrogen is sometimes seen in a patient injured during a prolonged alcoholic state or domestic beating, after which the patient is reluctant to seek medical attention, or with a physician misdiagnosis. In patients with pelvic fractures, the incidence of bladder rupture is 6 to 10 per cent. A retrograde cystogram with bladder filling of 400 ml of radiopaque dye followed by a washout film will diagnose intraperitoneal and extraperitoneal ruptures of the bladder. False-negative cystograms occur with penetrating injuries of the bladder when only 250 ml or less of contrast medium is used to fill the bladder.