CT Cystography: Radiographic and Clinical Predictors of Bladder Rupture

Desiree E. Morgan 1 ; Lakshmi K. Nallamala 1 ; Philip J. Kenney 1 ; Matthew S. Mayo 2 ; and Loring W. Rue 3

1 Department of Radiology, University of Alabama, 619 S. 19th St. Birmingham, AL 35233.
2 Department of Biostatistics, Kansas Cancer Institute, 3901 Rainbow Blvd., Kansas City, KS 66160-7312.
3 Department of Surgery, The Trauma Center of the University of Alabama, Birmingham, AL 35233.
Received March 23, 1999; accepted after revision June 15, 1999.

OBJECTIVE: Our goal was to identify radiographic and clinical variables that correlate with bladder rupture that may then be used as selection criteria for CT cystography in trauma patients.

SUBJECTS AND METHODS: Hemodynamically stable trauma patients with hematuria were examined under standardized protocol with dynamic oral and IV contrast-enhanced CT of the abdomen and pelvis, followed immediately by CT cystography. CT cystography consisted of contiguous 5-mm axial scans of the pelvis after retrograde distention of bladder with 300-400 ml of 4% iodinated contrast material. Radiographic and clinical variables (pelvic fracture, pelvic fluid, intraabdominal visceral injury, degree of hematuria, hematocrit, units of blood transfused, base deficit, injury mechanism, seat belt use, sex, age) were assessed and statistically analyzed using the two-tailed Fisher’s exact test and Wilcoxon’s rank sum test. Positive and negative individual and multivariate predictors were analyzed.

RESULTS: Of the 157 patients entered in our study, 12 (eight males and four females) had bladder rupture. One or more pelvic fractures were present in nine (75%) of the 12 patients (p < 0.001). Pubic symphysis diastasis, sacroiliac diastasis, and sacral, iliac, and pubic rami fractures were statistically associated with bladder rupture. Isolated acetabular fractures did not correlate with rupture. Eight (67%) of the 12 patients with bladder rupture revealed on CT cystography had gross hematuria (p < 0.001). No ruptures were seen in patients with <25 RBC/HPF (red blood cells per high-power field). All patients with rupture had pelvic fluid revealed on standard contrast-enhanced CT (p < 0.001).

CONCLUSION: Gross hematuria, pelvic fluid, and specific pelvic fractures were highly correlated with bladder rupture; identification of these findings may help in selection of trauma patients for CT cystography.