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JU INSIGHT: Alcohol Intoxication Is Associated With Bladder Injury and Bladder Surgical Repair in Patients Sustaining Motor Vehicle Collisions<

By: Jason L. Lui, BS; Nizar Hakam, MD; Nathan M. Shaw, MD; Joseph Cuschieri, MD; Behzad Abbasi, MD; Benjamin N. Breyer, MD | Posted on: 01 Nov 2022

Lui JL, Hakam N, Shaw NM, Cuschieri J, Abbasi B, Breyer BN. Alcohol intoxication is associated with bladder injury and bladder surgical repair in patients sustaining motor vehicle collisions. J Urol. 2022;208(5):1090-1097.

Study Need and Importance

Alcohol intoxication is a known risk factor for motor vehicle collisions (MVCs). With the combination of diuresis and risk of pelvic trauma, the risk of bladder dome injury is thought to be elevated in this population. We hypothesize ethanol intoxication increases the risk of bladder injury and surgical repair, especially at higher blood alcohol content levels.

Figure. Odds ratio comparison across blood alcohol concentration categories for outcomes of bladder injury and bladder repair.

Figure 1. Inflammation is a causative or exacerbating factor in virtually all UCICs. Listed with inward pointing arrows are conditions known to have an inflammatory component. For those underlined, the NLRP3 inflammasome has been shown to play a major role in triggering this inflammation. Inflammation leads to bladder dysfunction (overactive or underactive bladder) and 3 major physiological changes, fibrosis, denervation and smooth muscle hypertrophy (although not all changes are found in all conditions, eg diabetes). Ultimately such changes can lead to decompensation and end-stage bladder dysfunction.

What We Found

We identified 594,484 patients with MVCs in the National Trauma Data Bank®, 97,831 (16.5%) of whom had a positive alcohol screen. Patients intoxicated with alcohol were more likely to have a bladder injury (1% vs 0.4%, P < .001) and receive bladder surgical repair (0.7% vs 0.15%, P < .001) compared to nonintoxicated patients. This risk increased with rising blood alcohol concentration (see Figure). Remarkably, alcohol intoxication above the legal limit (blood alcohol content ≥ 0.08) was more predictive of bladder surgical repair than pelvic fracture. Additionally, seat belt use in combination with alcohol intoxication further increased the risk of bladder repair.

Limitations

As alcohol screening was not done in a systematic manner in the study population, there were 239,739 patients with no data for alcohol screening. The choice was made to incorporate these patients (who had all other variables intact) in the unexposed groups rather than exclude them from analysis. Any bias would diminish the study effect and trend toward the null hypothesis (alcohol is not related to bladder injury or repair), therefore this risk was felt to be minimal.

Interpretation for Patient Care

Alcohol increases the risk of operative bladder injuries for patients injured in MVCs. Intoxication, particularly above the legal limit, is more predictive of bladder injury requiring surgical repair than pelvic fracture. Trauma providers should have a high index of suspicion for intraperitoneal bladder injuries in alcohol intoxicated patients, particularly those with seat belt restraints.

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