Objective
To review current literature regarding uroabdomen in dogs and cats with respect to etiology, diagnostic approach, medical and surgical treatment, and prognosis.

Etiology
Uroabdomen in dogs and cats is most often associated with vehicular or blunt trauma. This condition may also result from urinary tract obstruction, traumatic bladder expression or catheterization, neoplasia, and postoperative leakage following abdominal or urogenital surgery.

Diagnosis
Disruption to the urinary tract should be considered when a patient is diagnosed with azotemia, hyperkalemia, and abdominal effusion. By comparing the creatinine concentration of the abdominal fluid to the serum or plasma creatinine concentration, a diagnosis of uroabdomen can be made if the creatinine ratio is ≥2:1. In most patients imaging studies with contrast are necessary to identify the exact source of urine leakage and to determine therapeutic options.

Therapy
Uroabdomen is a medical emergency, not a surgical emergency. Acute management involves stabilization of the patient with IV fluid therapy and treatment of hyperkalemia. Urinary diversion and, in some cases, peritoneal dialysis are necessary to stabilize the patient until life-threatening conditions such as hyperkalemia or concomitant injuries such as pulmonary contusions resolve. Once the patient is stable for anesthesia, surgical repair, if indicated, may be performed.

Prognosis
The prognosis of patients with uroabdomen depends on the extent of urinary and nonurinary injuries as well as the development of complications. Potential complications include dehiscence or urine leakage following surgical repair of the urinary tract, urosepsis, unresolving azotemia secondary to renal damage or underlying renal insufficiency, or stricture formation in the urinary tract.

A clinical review of pathophysiology, diagnosis, and treatment of uroabdomen in the dog and cat

We present a case of spontaneous rupture of bladder diverticulum three years after postoperative whole pelvic irradiation (50.4 Gy) for carcinoma of the uterine cervix. The patient had suffered from a neurogenic bladder after hysterectomy, but excretory urography revealed no abnormalities. Bladder diverticulum was found two years later. Spontaneous rupture of the urinary bladder is one of the late complications associated with radiotherapy, although it is very rare. Postoperative neurogenic bladder may also be associated with rupture. We should be aware of this rare complication in patients who receive pelvic irradiation.

Spontaneous rupture of bladder diverticulum after postoperative radiotherapy for carcinoma of the uterine cervix: a case report.

Received June 2008 Accepted August 2008 INTRODUCTION Pelvic irradiation is known to cause several complications involving urinary bladder such as radiation cystitis, ulceration, and incontinence.(1,2) Spontaneous intraperitoneal rupture of the urinary bladder is a rare complication following pelvic irradiation.(3-5) To the best of our knowledge, there is only one report of radiation-induced bladder rupture following irradiation for prostate cancer which was managed surgically.(6) Here, we present a case of spontaneous intraperitoneal bladder rupture occurred 8 months after adjuvant radiotherapy for prostate cancer that was successfully managed conservatively.

/pdf/conservative-management-of-early-bladder-rupture-after-ud2woa3jgh.pdf

Conservative Management of Early Bladder Rupture After Postoperative Radiotherapy for Prostate Cancer

The case is reported of a patient presenting with ascites and acute renal failure resulting from spontaneous rupture of the urinary bladder, 30 years after the successful initial treatment of childhood rhabdomyosarcoma. The delay in the presentation until the patient began to experience the symptoms due to urinary ascites, the diagnostic dilemma because of the rarity of the condition, and the possible aetiologies are discussed.

https://pmj.bmj.com/content/postgradmedj/84/995/502.full.pdf

When ascites is not ascites.

Background Indwelling Foley catheter is a rare cause of urinary bladder perforation, a serious injury with high mortality that demands accurate and prompt diagnosis. While the gold standard for diagnosis of bladder injury is computed tomography (CT) cystography, few bladder ruptures associated with Foley catheter have been reported to be diagnosed in the emergency department (ED). Case Report An 83-year-old man with indwelling Foley catheter presented to the ED for hematuria and altered mental status. He was diagnosed to have intraperitoneal rupture of the urinary bladder in the ED using abdominal and pelvic CT without contrast, which demonstrated bladder wall discontinuity, intraperitoneal free fluid, and pneumoperitoneum. The patient was treated successfully with medical management and bladder drainage. Why Should an Emergency Physician Be Aware of This? To our knowledge, this is the first report of intraperitoneal urinary bladder perforation associated with Foley catheter diagnosed in the ED by CT without contrast. Pneumoperitoneum found in this case was a clue to the diagnosis and is a benign finding that does not necessitate urgent surgical intervention. The early and accurate diagnosis in this case allowed for effective management with good clinical outcome. The use of indwelling Foley catheter has a high prevalence, especially in long-term care facility residents, who are frequent visitors in the ED. Therefore, emergency physicians and radiologists should be familiar with the presentation and imaging findings of this potential injury associated with Foley catheters.

Intraperitoneal Urinary Bladder Perforation with Pneumoperitoneum in Association with Indwelling Foley Catheter Diagnosed in Emergency Department.

We report a case of generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder. A 74-year-old female was admitted with abdominal pain and biochemical findings of acute renal failure (ARF). She had recently complained of macrohematuria. She had a past history of radiotherapy for uterine cervical cancer and Parkinson's disease treated with levodopa and amantadine. We diagnosed this case as intraperitoneal rupture of the bladder by cystogram. Biochemical findings of ARF might have resulted from urine reabsorption. Intraperitoneal rupture of the bladder should be considered in all cases of peritonitis, especially in patients with urological symptoms and features of ARF.

Generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder

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Generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder