Investigating the timing of catheter removal after traumatic bladder injury: a single-institution 12-year experience.

Abstract

Abstract:

Introduction: Traumatic bladder injuries, although rare, may result in significant patient morbidity. Operative management is recommended for intraperitoneal (IP), mixed, and select extraperitoneal (EP) injuries. Current guidelines lack recommendations on catheter duration following operative repair and suggest follow-up cystography may be unnecessary for simple, repaired injuries. This has led to practice variation in postoperative management at our institution. We hypothesized that the trauma surgery service would have a shorter catheter duration and obtain fewer follow-up cystograms compared with the urology service, without increased complications.

Methods: A retrospective review was conducted at a single level 1 trauma center between January 2010 and December 2022. All patients with traumatic bladder injuries during this period were included from the trauma registry. Those who were <18 years of age, lacked a full-thickness injury, died within 7 days of presentation, had a concomitant urethral injury or complex injury, did not undergo surgical repair, were lost to follow-up, underwent surgical management elsewhere, or had an iatrogenic injury were excluded. Data on patient demographics, management, and complications were recorded. Injuries were classified as complex when involving the trigone, ureters, or bladder neck, or were described as complex in the operative report.

Results: Of the 178 patients identified, 86 met the inclusion criteria. IP injuries were most common (43%), followed by EP (31%), and mixed (26%). Patient outcomes following the repair of simple injuries were similar regardless of the team performing the repair, although differences in catheter duration (11 days vs 17 days, p=0.006) and use of postoperative cystography (77% vs 100%, p<0.001) were observed (trauma vs urology, respectively).

Conclusion: Variations in postoperative management regarding catheter drainage and follow-up imaging for simple bladder repairs resulted in similar leak and complication rates. Our findings present an opportunity to reduce the duration of postoperative catheter drainage and cystography use in simple repairs.

Level of evidence: IV.