Uroabdomen defined as rupture into peritoneal cavity or retroperitonealcavity or both.
• Urinary bladder rupture is most commonly due to blunt trauma to
abdomen or pelvis; probability increases with degree of bladder
distention.
• Rupture of the prostatic or membranous portion of urethra is most
common site in dogs with urethral injury.
• Ureteral rupture less common; usually proximal if it occurs.
• Kidney trauma is not common; fracture of spine or caudal 3 ribs should
increase concern for renal injury.
• Hyperkalemia is a primary concern; review of treatment is provided.
• Chemical peritonitis can be painful; appropriate analgesia is indicated.
• Diagnosis is based on history, physical examination, laboratory evaluation,
and imaging.
– Palpable bladder does not rule out a leak or rupture nor does voiding
urine without gross hematuria.
– Peripheral blood to abdominal fluid creatinine > 2:1 100% specific,
86% sensitive, potassium > 1.4:1 100% sensitive & specific.
– Techniques described for imaging: survey radiographs have limited
usefulness, ultrasound is limited for detecting site of rupture, contrast
cystography is diagnostic modality of choice; excretory urography is
useful for ureters; imaging studies may be negatively impacted by
feces in colon.
– Computed tomography is the diagnostic of choice in human medicine;
MRI is less established.
• Treatment
– Urine diversion options: indwelling urinary catheter, cystostomy tube,
peritoneal drainage, renal replacement therapy.
– Surgery often indicated but stabilize patient first; overview of surgical
procedures is provided.
– Urethral trauma needs indwelling catheter or cystostomy as exposure
to urine can delay healing and cause strictures; less severe injuries may respond to up to 3 weeks of indwelling catheter; must confirm catheter has not passed through urethral defect.
• Antimicrobial therapy is indicated in high-risk patients, but is controversial
in low-risk patients.
• Delayed diagnosis is associated with mortality in humans.