An algorithm for diagnostics and treatment of intraperitoneal rupture of the bladder

Introduction. An increase in the number of road traffic injuries, crime rates and alcohol abuse has led to the rise in the frequency and severity of closed traumas of the urinary bladder. However, many issues related to the diagnostics and treatment of patients with such traumas, especially those who suffer from intraperitoneal rupture of the bladder, are developed poorly. The aim of the study was to clarify the role of modern methods of videoassisted laparoscopy in diagnostics and operative treatment of intraperitoneal rupture of the bladder. Materials and methods. Over the past 10 years, 36 patients with intraperitoneal rupture of the bladder aged from 14 to 74 years old have entered treatment in the department of urology of the Perm State Medical University. For diagnostics and treatment by video-assisted laparoscopy, Karl Storz video complex equipment was used. Results and discussion. The sensitivity scores of conventional methods for urinary bladder rupture diagnostics were the following: 83.3% for retrograde cystography, 69.2% for ultrasonography and from 0% to 61.6% for cystoscopy and Zeldovich test, respectively. When video-assisted laparoscopy was applied, urinary bladder rupture was diagnosed in all patients, which indicates its leading role in diagnostics of this pathology. An algorithm for diagnostics and treatment of intraperitoneal rupture of the urinary bladder was developed. This algorithm should be followed during videoassisted laparoscopy aimed at minimally invasive 3-0 vicryl suture of urinary bladder rupture during the first 12 hours following the trauma in case of an isolated rupture up to 6 cm in length and the absence of diffuse peritonitis. The indicated minimally invasive method was applied to 6 patients who demonstrated good short-term and long-term clinical outcomes and the absence of complications and lethal outcomes. Conclusions. Modern video-assisted laparoscopy yields good results and lowers the duration of rehabilitation 1.9-fold in comparison with the open repair of urinary bladder rupture during laparotomy.