Bladder trauma remains a significant cause of long-term voiding dysfunction, with injury patterns varying markedly by mechanism. The interaction between specific injury patterns and their management continues to challenge trauma teams. Prior studies have inadequately characterised how these injury patterns influence functional recovery, leaving critical gaps in prognostication and treatment algorithms.

This study evaluated 27 patients with bladder trauma to identify predictors of persistent lower urinary tract symptoms (LUTS). Using a retrospective cohort design (2019–2021), we analysed outcomes by injury severity (Injury Severity Score), associated fractures, and treatment strategy. Outcome measures included ICIQ (0-21) and OABSS (0-15) scores collected at 6- and 12-month follow-ups, with multivariate regression adjusting for age and Injury Severity Score. All cases of bladder perforation were confirmed by CT cystogram studies. Iatrogenic bladder rupture or trauma were excluded from the study.

At 6-month follow-up, patients with pelvic fractures demonstrated significantly worse LUTS (mean ICIQ 15.1 vs. 7.3, p<0.01) and 3.2× higher complication rates (p=0.02). High-energy mechanisms (MVCs, falls >2m) correlated with slower symptom resolution (ΔICIQ-6_12mo: -3.1 vs. -4.9 in low-energy injuries, p=0.03). Conservative management yielded superior outcomes, with 82% achieving mild symptoms (ICIQ≤8) versus 58% of surgical cases (p=0.04). Age ≥50 years independently predicted poorer recovery (OABSS improvement Δ-2.1 vs. Δ-3.8, p=0.03).

These findings highlight pelvic fractures and high-energy trauma as critical determinants of long-term voiding dysfunction, while supporting selective non-operative management for stable injuries. Protocolised urodynamic screening should be prioritised for high-risk patients, particularly older adults and those requiring emergent surgery.