A prospective study on the management of urinary bladder injuries in a military hospital in Yemen.

Abstract

Background: Urinary bladder (UB) injuries pose significant challenges in conflict zones, yet evidence on optimal management in resource-limited settings remains scarce. This study evaluates outcomes of conservative and surgical approaches for UB injuries in war-torn Yemen.

Methods: This prospective observational study was conducted at a tertiary military hospital in Sana'a, Yemen, from February 2021 to January 2023. Forty-four patients with traumatic UB injuries were enrolled. Injuries were classified by mechanism, AAST grade, and anatomical location. Conservative management included catheterization and antibiotics, while surgical intervention was guided by injury severity and associated trauma. Outcomes included healing confirmed by cystography, complication rates (Clavien-Dindo classification), and length of hospital stay.

Results: Of 44 patients (95.5% male; mean age 26.8 ± 8.6 years), 77.3% underwent surgical repair, primarily for penetrating injuries and high-grade bladder trauma. Conservative management was applied in 22.7% of low-grade extraperitoneal cases. Surgical success rate was 97.1%, while conservative success reached 80%. Most patients (82.4%) had extraperitoneal injuries; associated trauma was common, including pelvic/femur fractures (68.2%) and abdominal/pelvic organ injuries (36.4%). Complications occurred in 36.4% of patients, with 13.6% being moderate to severe (Grade III-IV). No bladder injury-related mortalities occurred. Pelvic fractures significantly increased the odds of surgical repair (OR 4.2, p = 0.001) and late sepsis (OR 5.6, p = 0.02).

Conclusion: In conflict settings, surgical repair remains critical for high-grade UB injuries, while conservative management is viable for select low-grade cases. Prolonged hospitalization reflects polytrauma burden rather than surgical intervention itself.