Introduction

Bladder trauma is a relatively uncommon presentation, with a variation in its incidence across various age groups. In adults, an estimated 65–86% of bladder injury is as a result of blunt trauma. In contrast, penetrating trauma accounts for 14–35% of bladder injuries in adults ^[1]. The incidence of iatrogenic bladder injury ranges from 0.04% to 58%, depending on the type of procedure ^[2]. The overall incidence of bladder injury in children following abdominopelvic trauma is higher than the adult population as the bladder is less well protected ^[3].

The most widely recognised practical classification of bladder injury relates to the site of injury, i.e., intraperitoneal, extraperitoneal, or both. This plays a key role in guiding patient management ^[4]. In contrast, the American Association for the Surgery of Trauma (AAST) classification of bladder injuries is based on the size and site of injury (Table 1) ^[5]. However, this classification has not been adopted by any of the other guidelines included in this review.

Table 1. The AAST classification of bladder injuries

Grade	Injury
1	Contusion, intramural haematoma, or partial thickness laceration
2	Extraperitoneal bladder wall laceration <2 cm
3	Extraperitoneal >2 cm or intraperitoneal <2 cm bladder wall laceration
4	Intraperitoneal bladder wall laceration >2 cm
5	Intra- or extraperitoneal bladder wall laceration involving the trigone or bladder neck

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Bladder Trauma: A Guideline of the Guidelines; Reddy D, Laher AE, Moeng M, Adam A_6; BJU International published by John Wiley & Sons Ltd on behalf of BJU International. 2024; 133(3):365–374. doi:10.1111/bju.16236._2024