Stafford JR, Bartges JW. J Vet Emerg Crit Care 23(2) 2013, pp 216–229
doi: 10.1111/vec.12033
Background
None.
Rational and Objective
Review literature regarding uroabdomen in dogs and cats with respect to etiology, diagnostic approach, medical and surgical treatment, and prognosis.
Trial Design
Literature review.
Patient Population & Location
Reference list of 130 papers – human and animal (large, small, research)
Methods
Review of literature.
Endpoints (if applicable)
N/A
Results
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.
Limitations
• Review focuses on all causes of uroabdomen, not just trauma.
• Publication is 10 years old.
Clinical Relevance & Conclusions
• No real conclusions regarding prognosis in small animals.
• Human urinary bladder is retroperitoneal so caution in interpreting human studies versus animal studies.