Limitations of routine spiral computerized tomography in the evaluation of bladder trauma

Purpose: We evaluate the accuracy of spiral computerized tomography (CT) in diagnosing traumatic bladder rupture. Materials and Methods: Medical records of 24 consecutive patients diagnosed with traumatic bladder rupture at our level 1 trauma center from 1993 to 1998 were retrospectively reviewed. Of the patients 15 underwent retrograde cystography and spiral CT of the abdomen and pelvis. The results of these imaging studies were compared. Results: Retrograde cystography successfully diagnosed all cases of bladder rupture and correctly classified injuries confirmed surgically. Spiral CT successfully diagnosed 9 of 15 bladder ruptures (60%), and correctly classified 4 of 5 intraperitoneal (80%) and 6 of 11 extraperitoneal (55%) ruptures. Conclusions: Spiral CT is less accurate than retrograde cystography in diagnosing traumatic bladder rupture.