Spontaneous (idiopathic) rupture of the urinary bladder: a systematic review of case series and reports

Abstract

Objectives To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated comorbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity and mortality associated with the presentation of SRUB. Methods The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Results A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (interquartile range [IQR]) age of all included patients was 47.5 (33–65) years. The median (IQR) time to presentation was 48 (24–96) h, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common, with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%. Conclusion This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasized the high rate of misdiagnosis and challenge in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition.

Bladder malignancy as a cause of spontaneous bladder rupture: A systematic review

“…In this study, the median age was much younger at 59 years old, and the male‐to‐female ratio was 1.7:1. A review of patients with spontaneous bladder rupture (although excluding bladder cancer patients) found that spontaneous bladder rupture was more common in women 2 . They note vaginal delivery as a risk factor for this 2 .…”

“…2 They note vaginal delivery as a risk factor for this. 2 Post-menopause, the bladder can become thinner and lose elasticity in women; a combination of hormonal and post-pregnancy factors may partially account for why there seems to be a proportionally higher number of women in this review of bladder rupture secondary to malignancy. In this review, spontaneous bladder rupture was the first presentation of bladder cancer in most cases.…”

“…10 The presentation of spontaneous bladder rupture is usually with abdominal pain and symptoms of peritonism. 2 The most common presentation of bladder cancer is painless macroscopic haematuria, with urinary frequency or urgency symptoms. 12 One fifth of patients in this review presented with haematuria, and just under one third of cases also had urinary symptoms.…”

“…More common causes of spontaneous rupture of the urinary bladder include bladder outlet obstruction, overdistention, inflammation and infection 2 . Weakening of the bladder wall and neurogenic processes that reduce the awareness of bladder distension contribute to the pathogenesis of spontaneous bladder rupture, with diabetes, alcohol intoxication and post‐radiotherapy being major associations 2 . A rare cause of spontaneous urinary bladder rupture is malignancy, often presenting as advanced disease (locally and systemically) with a poor prognosis.…”

Marked urinary retention: Potentially misleading gynecologists into diagnosing the condition as a giant ovarian cyst

“…UR patients with mental disorders or alcohol abuse sometimes do not complain of voiding difficulties, and sometimes suffer bladder rupture. 1,2 This patient had no such conditions. Absence of renal-dysfunction data and no hydronephrosis suggest that the episode was acute and transient.…”