الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Trauma is a leading cause of morbidity and mortality all over the world. Urinary tract injuries occur in 3%–10% of all abdominal trauma patients. Bladder trauma represents a minority of these cases. However, early recognition and accurate diagnosis of ruptured bladder together with definitive treatment are essential in any attempt to lower the mortality rate.
CT cystography is the diagnostic procedures of choice for suspected bladder injury. Bladder injuries can be divided into five types, after Sandler et al classification, based on the extent of injury seen radiographically. The type of injury is determined by the degree of wall injury and anatomic location. These types are urinary bladder contusions, intra-peritoneal rupture, interstitial injuries, simple and complex extra-peritoneal ruptures and combined extra- and intra- peritoneal ruptures.
In addition to injury type, the data provided by CT cystography is used in grading urinary bladder injuries after the Organ Injury Scale of the American Association for the Surgery of Trauma. The advantages of this grading system are that it has correlation between grade and injury severity, and it has predictive value regarding potential morbidity.
The study was carried out on 33 patients with clinically suspected traumatic urinary bladder injury. Twenty patients (60.6%) were males and thirteen patients (39.4%) were females. Twenty-five eight patients (75.8%) suffered blunt abdominal trauma with road traffic accidents being the most common cause (60.6%), while penetrating trauma was encountered in 8 patients (24.2%). The vast majority of patients (90.9%) presented with hematuria and nearly half of the patients (51.5%) had pelvic contusions. Nine patients (27.3%) had isolated urinary bladder injury while twenty-four patients (72.7%) had other associated injuries with pelvic fractures being the most common associated injury.
The patients were subjected to full history taking, clinical examination, FAST sonographic assessment and CT cystography examination either with intravenous or retrograde technique.
All patients were classified according to Sandler et al classification into five types. The most common type of urinary bladder injuries encountered in our study was complex extra-peritoneal injuries represented in fourteen patients (42.4%). Both intra-peritoneal and combined intra- and extra-peritoneal urinary bladder ruptures were equally presented; each encountered in six patients (18.2%). This was followed by simple extra-peritoneal injuries observed in four patients (12.1%), urinary bladder contusion was observed in two patients (6.1%) and the least commonly observed injuries was intestinal urinary bladder injury; each encountered in one patient (3.0%).
All patients were also classified according to the AAST grading system into five grades. Grade I injury was diagnosed in 3 patients (9.1%), grade II in 11 patients (33.3%), grade III in 11 patients (33.3%), grade IV in 7 patients (21.2%) and grade V in one patient (3.0%).
Seven patients (80.5%) were managed conservatively, twenty-five patients underwent surgical repair and one patient underwent angiographic embolization.
In this study, CT cystography provided expedient evaluation of urinary bladder injuries with high degree of sensitivity and specificity. Urinary bladder injuries have characteristic CT cystography features that can be used for accurate diagnosis, classification and better treatment planning.