Osman Y et al. (2005) Nonoperative treatment of isolated posttraumatic intraperitoneal bladder rupture in children—is it justified? J Urol 173: 955–957

Nonoperative treatment is considered appropriate in the management of bladder rupture following augmentation enterocystoplasty. A study by Osman et al. now considers this approach in children with post-traumatic intraperitoneal bladder rupture.

Eight children were treated for intraperitoneal bladder rupture following road traffic accidents or a direct blow to the full bladder. The four patients who presented early in the series (group 1) underwent classic open repair, whereas the next four children (group 2) were treated conservatively, with adequate bladder drainage using a urethral catheter or a suprapubic tube, and percutaneous intraperitoneal tube drain through the iliac fossa.

All the patients in group 2 showed significant improvements in their general condition within a few hours of treatment, none required surgical intervention, and no complications occurred. Mean indwelling catheter duration and mean hospital stay were similar in groups 1 and 2.

Rehman et al. conclude that the nonoperative approach described is justified in the initial treatment of children with isolated intraperitoneal bladder rupture, provided that concomitant injuries are ruled out. They advise that improper bladder drainage, prolonged urinary drainage through the peritoneal drain and/or lack of clinical improvement within the first few hours are indications for surgical intervention.