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UROGENITAL
TRAUMA
Traumatic
rupture of the urinary bladder: is the suprapubic tube necessary?
Parry NG, Rozycki GS, Feliciano DV, Tremblay LN, Cava RA, Voeltz Z, Carney
J
Department of Surgery, Grady Memorial Hospital, Emory University School
of Medicine, Atlanta, Georgia, USA
J Trauma. 2003; 54: 431-6
- Background:
Although surgical principles are well accepted for the treatment
of an intraperitoneal or extraperitoneal rupture of the urinary bladder,
the type and number of drainage catheters needed to obtain a satisfactory
outcome with minimal patient morbidity have yet to be determined.
- Methods:
This was a retrospective review of data on injured patients with the
diagnosis of an intraperitoneal or extraperitoneal rupture of the urinary
bladder from penetrating or blunt trauma.
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Results:
Of the 51 patients identified, 28 were treated with suprapubic and transurethral
catheters, whereas 23 received a transurethral catheter only. Complications
and catheter duration times were similar regardless of type of bladder
injury or drainage catheter used (p > 0.5).
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Conclusion: These
data suggest that there are similar outcomes and complication rates
for patients treated with suprapubic and transurethral catheters versus
transurethral catheter only. Transurethral catheters alone seem effective
in draining all types of bladder injuries.
- Editorial
Comment
For many years, by habit, many of us have been placing suprapubic tubes
(SPT) at the time of open bladder repair. However, this is only one
of many papers that advocate using only a urethral catheter alone in
these patients (1-3). It appears that using a urethral Foley catheter
alone allows for low complications with minimal morbidity. The rate
of urinary tract infection, in this study at least, is identical between
both groups. In no cases in this small group of 51 patients did a patient
seem to “require” the SPT (either as a “safety valve”
or to facilitate irrigation).
Although I agree that most bladder injuries may be treated with urethral
catheterization alone, there are some theoretical benefits to using
a SPT. Patients with SPTs get their urethral catheters removed 11 days
earlier in this series (with continued drainage via SPT), which may
be more comfortable for the patient. Also, the suprapubic catheter allows
for a theoretic “safety valve” if the urethral catheter
becomes clogged or inadvertently dislodged, although this was not necessary
in this series.
There are probably some uncommon cases where a suprapubic tube would
be prudent. In cases of severe ongoing hematuria which is observed in
the operating room, or in cases of truly devastating bladder injuries
(such as close range shotgun wounds to the bladder), an SPT might help
to maximize bladder drainage, especially in the unrepairable or unreliably
repaired bladder. Otherwise, the data is clear: after bladder repair,
consider using just a urethral catheter. We tend to use a 2-way catheter,
as we feel that continuous bladder irrigation is improper in a recently
repaired bladder, but the authors of this study place a 3 way Foley
and do use continuous bladder irrigation when necessary.
REFERENCES
1. Thomae KR, Kilambi NK, Poole GV: Method of urinary diversion in nonurethral
traumatic bladder injuries: retrospective analysis of 70 cases. Am Surg.
1998; 64: 77-80.
2. Alli MO, Singh B, Moodley J, Shaik AS: Prospective evaluation of combined
suprapubic and urethral catheterization to urethral drainage alone for
intraperitoneal bladder injuries. J Trauma. 2003; 55: 1152-4.
3. Volpe MA, Pachter EM, Scalea TM, Macchia RJ, Mydlo JH: Is there a difference
in outcome when treating traumatic intraperitoneal bladder rupture with
or without a suprapubic tube? J Urol. 1999; 161: 1103-5.
Dr.
Richard A. Santucci
Assistant Professor of Urology
Wayne State University
Detroit, Michigan, USA
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