The Role of Surgery in the Management of Complex Extraperitoneal Bladder Injury

Purpose of Review: This review focuses on the evolving role of surgical management for complex extraperitoneal bladder injuries. Recent Findings: Despite recommendations from both the AUA and EAU advocating bladder drainage for the treatment of most extraperitoneal bladder injuries, there appears to be an increasing role for early operative intervention in select cases of extraperitoneal bladder injury. Although there is a paucity of contemporary data regarding surgical outcomes, both simple and complex extraperitoneal bladder injuries are wrought with short- and long-term sequelae that may warrant early closure. Summary: Catheter drainage of bladder injuries is most appropriate for carefully selected, simple extraperitoneal bladder injuries. Bladder injuries, however, with complex parameters including those with intravesical bony fragments, concomitant internal pelvic fixation, involvement of bladder neck, rectum, and/or vagina, or those undergoing exploratory laparotomy for non-GU injuries, can benefit from early cystorraphy to avoid deleterious short- and long-term complications.