Indications for urgent radiographic evaluation of suspected bladder injuries are poorly defined. Review of the existing literature reveals that traumatic bladder rupture is strongly correlated with the combination of pelvic fracture and gross hematuria. Nearly all patients with hematuria or pelvic fracture alone do not have bladder rupture. Bladder rupture is commonly associated with suprapubic discomfort or inability to void in coherent, responsive patients. Intoxicated or unresponsive patients should warrant a higher index of suspicion for bladder injury among clinicians treating patients with pelvic trauma. Similarly, patients having neurologic or preexisting urologic co-morbidities may not manifest typical symptoms of bladder rupture. The above clinical indicators should be considered when clinicians determine the appropriateness of urgent cystography to detect bladder rupture.
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