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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20388
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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Can a punctured bladder be fixed? If so, how? Wife thinks

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Can a punctured bladder be fixed? If so, how?

Wife thinks non-elastic outside layer of the 2006 radiation-damaged bladder cracked due to incredible pressure of 500cc urine. Did an internal healthy layer of bladder take the path of least resistance and possibly got nicked (punctured) as it expanded through the outside "crust"? The thrombosis may be sealing the hole on inside of the bladder and/or the piece of "crust" is still stuck in the retracted bladder. Docs nixed dissolving clot with enzymes or suctioning it out. (Speaks to the puncture theory.) Where to look for 5 units of blood? Certainly did not all come down the catheter.
Hi there,
Thanks for your question. Please be patient for a response as I may be in the OR or driving, but will get back to you ASAP.
If the bladder look normal when the cystoscope was placed into the bladder, then he does not have a bladder rupture or a puncture in the bladder. People who have a bladder rupture become extremely ill with extreme abdominal pain. It is not like the outer side of the bladder develops a hole without a hole on the inside. The enlarged capacity was from urinary retention from the clots in the bladder. He certainly can lose five units of blood just through the catheter alone . If he continues to bleed, he will have to have medication such as formalin placed into the bladder to stop the bleeding. Hope this helps him please let me know if you have any other questions I can answer.
Customer: replied 6 years ago.

A time line for you. Radiation performed 2006. Cystoscopy & volume study done in 2007 with theory of radiation-damage-to-only-outside-of-bladder propounded for frequent urination, not responding to usual meds. Now- Sept.2010 - patient sent from a hospital to a rehab (PT), then to another hospital for emergency breathing issue. At 2nd hospital, urinary tract started producing blood/clots. The ultrasound was done with results as specified. After 45 days in ICU, patient was sent to a ventilator weaning hospital/rehab still with his unresolved urinary tract problem. Two weeks later and another round of IV antibiotics - cefepime & vancomycin - urinary tract still produces blood & clots. Would a thorough look at bladder (cystoscopy & exterior via laproscopy) be next? Or the formalin?

Also, would you please address just the original question in case a puncture did occur? How would you fix it?. Thank you very much.

A trip to the OR with cystoscopy is the next course of action to get the clots out and stop the bleeding with cautery. There is no role for laparoscopy in this situation. If there is no hole on the inside of the bladder, there is not going to be a hole on the outside. Even if the outside of the bladder was damaged from radiation, this would not have any effect on the bleeding as the bleeding comes from the mucosa on the inside. If a puncture occurred, it only needs to be fixed with an open exploration if the hole enters the abdominal cavity. If it does not enter the abdominal cavity, then the treatment is to leave a catheter in the bladder for 2 weeks and the hole will heal up on its own.
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