Nikilesh Babu

Background: The optimal duration of urinary catheterisation and the necessity of routine follow‐up cystogram prior to catheter removal in non‐iatrogenic bladder injury remain controversial. International guidelines vary, and no local protocol exists. This study reviewed our institutional experience to evaluate the yield of routine cystogram prior to catheter removal. Methods: A retrospective audit was conducted of patients with non‐iatrogenic bladder injuries managed at a Level 1 trauma centre between 2005 and 2024. Patients with partial thickness or complex injuries and those who died within 7 days were excluded. Demographics, injury characteristics, management strategy, catheter duration, use of follow‐up cystogram and complications were analysed. Urinary tract infection was defined as a clinically diagnosed or microbiologically confirmed urinary infection documented during admission requiring antibiotic treatment. Intraperitoneal (IP) and extraperitoneal (EP) injuries were compared using non‐parametric and categorical statistical tests. Follow‐up cystography at our institution was performed using conventional fluoroscopic cystography. Contrast was instilled retrograde through an indwelling urethral catheter using diluted Omnipaque 350 in saline. The bladder was passively filled to approximately 300–350 mL, or until the patient reported fullness or resistance to filling was encountered. Standard anteroposterior and oblique radiographs were obtained. A positive cystogram was defined as any radiologically reported contrast extravasation consistent with a persistent urinary leak. Results: Thirty‐two patients were included (53% male; median age 35 years [IQR 26–53]). All included cases were attributable to blunt trauma. Eighteen (56%) injuries were IP and 14 (44%) EP. Twenty‐two (69%) injuries underwent operative repair. Thirty patients (94%) underwent routine follow‐up cystogram prior to catheter removal; all studies were normal. The median duration of catheterisation was 17 days (IQR 11–25). Urinary tract infection occurred in 38% of patients. Patients who developed urinary tract infection had a longer median duration of catheterisation compared with those who did not develop urinary tract infection (27 days [IQR 12–34] vs. 15 days [IQR 10–22]). There were no urinary leaks identified following catheter removal and no mortality within the available follow‐up documentation. Conclusion: Routine follow‐up cystogram prior to catheter removal demonstrated a very low diagnostic yield in uncomplicated non‐iatrogenic bladder injuries within our cohort. Prolonged catheterisation was common and associated with high rates of urinary tract infection. A selective approach to cystography and earlier catheter removal in uncomplicated injuries, particularly following IP repair, may be appropriate.

Few studies on equestrian-related injuries have specifically focused on patients in South Africa. The aim of this study was to review the spectrum of injuries and of patients treated at state-funded trauma centres in South Africa. A retrospective study was conducted over a 12-year period from July 2012 to February 2025 on all patients treated for equestrian-related injuries. A total of 82 patients were included (83% male, median age: 17 years, median injury severity score (ISS): 9). The most common mechanism of injury was a fall (n = 41), followed by a kick (n = 38). Two were trampled, and one dragged. The most commonly injured body regions were head and neck (n = 49), face (n = 29), and chest (n = 17). Eighty-two per cent (67/82) were managed non-operatively. The overall morbidity was 21% (17/82). Respiratory complications were the most common (n = 7). The median length of hospital stay was two days (range 0-45). There were two mortalities (2%), both due to a fall from a horse resulting in severe traumatic brain injury (TBI). Horse-related injuries are serious and can result in significant injuries. A significant number of patients required major operative interventions. Both riders and non-riders are at risk of injury and appropriate safety equipment and education is essential.