How would you treat an extraperitoneal bladder injury?

• A. Urgent surgical repair
• B. Suprapubic cystostomy
• C. Foley catheter placement
• D. Observation only

Answer: (C)

In the case of an extraperitoneal bladder injury, the correct approach is often to perform Foley catheter placement. This method is used to allow for bladder drainage and promote healing in the setting of a non-operative injury. An extraperitoneal bladder injury typically occurs from blunt trauma and involves the bladder wall without contaminating the peritoneal cavity.

By placing a Foley catheter, the bladder is decompressed which helps minimize extravasation of urine into the surrounding tissues, allowing for spontaneous healing without risking further complications. The catheter provides a controlled way to drain urine, which is crucial in cases where the bladder is damaged but not requiring immediate surgical intervention.

Other options may be applicable in certain circumstances; for instance, urgent surgical repair is indicated for intraperitoneal injuries or when there are significant complications like free urine in the peritoneal cavity. Suprapubic cystostomy is usually reserved for cases that may require long-term drainage or when urethral injury prevents safe urethral catheterization. Observation is a possibility in certain low-risk scenarios but is generally not the primary approach in managing bladder injuries.