The bladder is a pelvic organ and is generally not easily injured unless there is a pelvic fracture. When the bladder is overinflated, it is susceptible to injury if the lower abdomen is struck violently. According to the site of injury, it is categorized into extraperitoneal and intraperitoneal types. According to the cause of injury, there are three common types of injury: closed, open and medical injury. Diagnostic Criteria I. Clinical manifestations (1) If there is a history of lower abdominal trauma, pelvic fracture, or the following clinical manifestations occur after obstructed labor or instrumentation in the vesicourethra, the possibility of bladder injury should be considered. (b) Bleeding and shock: pelvic fracture combined with massive bleeding, bladder rupture resulting in urinary extravasation and peritonitis are often associated with severe shock. (C) dysuria and hematuria: bladder rupture, urine extravasation, puncture the bladder, the patient often have the urge to urinate and urgency, but can not urinate or only a small amount of hematuria discharged. (D) abdominal pain: urine extravasation and hematoma can cause severe pain in the lower abdomen, and urine flow into the abdominal cavity will cause acute peritonitis symptoms. (e) Urinary fistula: penetrating injury can lead to a body wound, rectal or vaginal leakage of urine. Closed injury in the urine extravasation of infection after ulceration, can also form a urinary minion. Second, auxiliary examination (a) catheterization: if the bladder is empty or only export a little bloody urine, the possibility of bladder rupture is very great. At this time can be injected into the sterile saline 300ml, wait a moment and then pumped back, if the amount of extraction is significantly less than the amount of injection, indicating that there may be bladder rupture urine extravasation. (B) X-ray examination 1. Cystography: the contrast agent can be seen to spill, intraperitoneal bladder rupture to the bladder after injection of gas to the abdominal fluoroscopy, you can see the diaphragm free gas. (2) Pelvic radiographs: to understand the pelvic fracture or foreign body retention. (C) Abdominal puncture: after intraperitoneal bladder rupture, due to a large amount of urine flow into the abdominal cavity, abdominal puncture can extract pale bloody fluid or urine. Principles of treatment I. Treatment of shock: including blood transfusion, rehydration and analgesia. Use antimicrobials to prevent infection as early as possible. Second, mild bladder injury or fresh instrument injury, no urine extravasation, can be left catheter for about 1 week can be more self-healing. Emergency surgery: 1, intraperitoneal bladder rupture: if there is a large amount of urine into the abdominal cavity caused by acute peritonitis, should be early surgical removal of intraperitoneal urine, blood clots and explore whether there is a combination of abdominal organ injury, saline irrigation of the abdominal cavity, suture the peritoneum and outside the bladder to repair the bladder fissure, bladder high-stage, bladder wound around the placement of drainage tubes. 2, extraperitoneal bladder rupture: severe extraperitoneal bladder extensive rupture, such as firearms penetrating injury or combined with pelvic fracture, bleeding and urine extravasation of significant, should be actively used in the surgical treatment, to remove the extravasation of urine and blood clots. For vesico-rectal penetrating injuries, temporary colostomy and cystostomy should be performed. If there are free bone fragments or shrapnel and other foreign objects in the bladder, they should be removed, and the necrotic tissues around the bladder incision should be trimmed, and the bladder should be repaired and a high bladder stoma should be performed, and the wound should be drained. 3, vesicovaginal fistula repair: bladder injury left after vesicovaginal fistula or vesicorectal fistula, in the patient’s general condition improves and local inflammation subsides, the use of surgical repair of vesicovaginal fistula.