Bladder rupture after road traffic accident: retrograde cystography
4-year-old male crossbreed hit by a car 24 hours ago, with pelvic fractures. He has passed small amounts of bloody urine. On the radiograph the bladder is not identified and there is loss of serosal detail in the caudal abdomen. The abdominal fluid is analysed:
| Parameter | Result | Reference |
|---|---|---|
| Serum creatinine | 2.4 mg/dL | 0.5–1.5 |
| Abdominal fluid creatinine | 7.8 mg/dL | Similar to serum |
| Serum potassium | 5.9 mmol/L | 3.5–5.5 |
Which imaging test best confirms the suspicion?
chevron_right Show answer and explanation
A. Positive-contrast retrograde cystography with diluted iodinated contrast, distending the bladder well and including a post-voiding view
Correct. Leakage of contrast into the peritoneum confirms rupture. The bladder must be well distended (with little volume a small tear may not leak) and water-soluble iodinated contrast must be used, never barium.
B. Double-contrast cystography using diluted barium
Barium is contraindicated if rupture is suspected: in the peritoneum it causes granulomatous peritonitis. Double contrast is for assessing the mucosa, not for detecting leaks.
C. None: if the dog urinates, the bladder is intact
A classic mistake. Many animals with bladder rupture continue to urinate, because the bladder retains part of the urine.
D. Intravenous excretory urography as first choice
It is useful for the ureter and kidney, but opacifies the bladder less well and adds a contrast load in a patient who may be azotaemic. For the bladder, the retrograde study is better.
lightbulb Key takeaway
Abdominal fluid creatinine more than twice the serum value supports uroabdomen. In males with pelvic fractures, combine cystography and retrograde urethrography to also assess the urethra. Seeing the bladder on plain radiographs does not rule out rupture.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.