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Urogenital Imaging

Bladder rupture, extraperitoneal

usually secondary to traumatic or iatrogenic injury. Eighty percent of bladder ruptures are extraperitoneal and generally the result of adjacent pelvic fracture or avulsion tears at the fixation points of puboprostatic ligaments. Extraperitoneal bladder rupture commonly occurs close to the bladder base. Extraperitoneal bladder rupture is subdivided into simple extraperitoneal bladder rupture (extravasation limited to the perivesical space) and complex (extravasation extending beyond the perivesical space to involve the scrotum or perineum). Sometimes a combined extra- and intraperitoneal bladder rupture is seen. Bladder ruptures, depending on their extent, can be treated conservatively.

Diagnostic evaluation of bladder rupture, is conventionally done with voiding cystourethrography (VCUG) or cystography (Fig.1). VCUG has historically been the preferred contrast-enhanced study for the diagnosis of bladder rupture. The bladder needs to be fully distended and evaluation of a postvoiding film is essential. Recently the use of CT cystogram has been advocated as more sensitive in the detection of small bladder rupture, having superb ability in differentiation between intra- and extraperitoneal bladder rupture and in addition to the detection of bladder rupture, ability to evaluate any other bony soft tissue injury.

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Fig.1

Cystogram showing extraperitoneal rupture of the bladder. The bladder is displaced to the right side.
Bladder rupture, extraperitoneal, Fig.1