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Comparison of surgical treatment of bladder rupture DOI: 10.29188/2222-8543-2020-13-5-86-90
- Isakov M.N. – junior researcher in department of emergency surgery, endoscopy and intensive care and urologist in 1st surgery department and N.V. Sklifosovsky research institute of emergency care; Moscow, Russia;
https://orcid.org/0000-0002-1833-2682 - Mikhaylikov T.G. – MD, urologist in 1st surgery department and researcher in department of emergency surgery, endoscopy and intensive care N.V. Sklifosovsky research institute of emergency care; Moscow, Russia;
https://orcid.org/0000-0002-8906-9228 - Yartsev P.A. – professor, Dr Sc., scientific chief in department of emergency surgery, endoscopy and intensive care N.V Sklifosovsky Research Institute of Emergency Care; Moscow, Russia;
https://orcid.org/0000-0003-1270-5414
940 Introduction. Еven though open bladder suturing is a traditional method of surgical treatment of intraperitoneal rupture of the bladder, laparoscopic bladder suturing is a prospective method for treating such injuries.
Materials and methods. In N.V. Sklifosovsky Research Institute of Emergency Care during the period from January 2016 to April 2020, 22 patients with bladder injury were treated. 15 of them had an intraperitoneal rupture, 5 had an extraperitoneal rupture, and 2 had a bladder rupture. Among the affected men there were 15 (68%), women - 7 (32%), the average age of patients was 42 ± 18 years. The clinical picture was dominated by gross hematuria and pain in the lower abdomen. All patients underwent ultrasound examination (US) according to the FAST protocol, and cystography was performed in some patients.
Results. 20 (91%) patients were operated and 2 (9%), with extraperitoneal rupture of the bladder, were drained by urethral catheters. Patients were divided by the method of surgical treatment into 2 groups. In the 1st group, 2 (10%) patients underwent laparoscopic suturing of the bladder with drainage of the bladder with a urethral catheter. 18 (90%) patients of the 2nd group underwent laparotomy with suturing of the bladder. Depending on the method of bladder drainage, patients were divided into the cystostomy group (group A) and the urethral catheter group (group B). Group A - 16 (73%) patients who underwent laparotomy, suturing a rupture or ruptures of the bladder, epicystostomy, drainage of the abdominal cavity and lower pelvis. Group B-4 (18%) patients after laparotomy, laparoscopy, as well as patients who underwent conservative therapy with the installation of an urethral catheter – 2 (9%).
Discussion. In the world literature, there are few scientific articles on the laparoscopic method of treating bladder injury, and the presented works are based on a small sample of patients. But, despite this, the method seems to be a promising and effective method for treatment and can be used in patients with intraperitoneal rupture of the bladder with stable hemodynamics, without life-threatening concomitant injuries.
Conclusion. Тhe use of open or laparoscopic suturing of the bladder without epicycostomy significantly reduces the hospital stay and allows to restore natural urination on average 7 days after surgery. Laparoscopic suturing of the bladder is an effective and alternative treatment for bladder rupture.
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