Early cystography after traumatic bladder repair is associated with shorter catheter duration and fewer CAUTIs without increased detection of postoperative leaks

BACKGROUND: Optimal postoperative management after traumatic bladder repair, such as imaging strategies and catheter duration, remains unclear and may affect the rate of catheter-associated urinary tract infections (CAUTIs). We evaluated early (≤7 d) versus late (≥8 d) or no postoperative cystography for traumatic bladder repairs, hypothesizing that early imaging would reduce catheter duration and CAUTI rates without increasing the rate of urinary leak detection. METHODS: We retrospectively reviewed trauma registry data from a university-based Level I and II trauma system from 2017 to 2024. Patients with full-thickness bladder injuries undergoing cystorrhaphy were included. Those with in-hospital mortality or concomitant ureteral and/or urethral injuries were excluded. Patients were stratified by timing of initial postoperative cystography: early versus late and early versus none. Primary outcomes included catheter duration, CAUTI rate, and urinary leak rate on initial postoperative imaging. RESULTS: One hundred eighteen patients met the inclusion criteria: 62 (52.5%) isolated intraperitoneal, 39 (33.1%) isolated extraperitoneal, and 17 (14.4%) combined injuries. Eighty-six (71.9%) sustained blunt trauma. Twenty-nine (24.6%) patients underwent early, 70 (59.3%) late, and 19 (16.1%) no postoperative imaging. There were more AAST grade 4 bladder injuries (79.3% vs. 45.7%, p<0.01) in the early versus late cystography cohort. Otherwise, there were no differences in patient demographics, mechanism, injury severity, associated injuries or interventions, or management strategies. Early postoperative imaging was associated with reduced catheter duration (7 [6-10] vs. 14 [11-18] d, p<0.01) and CAUTI rates (6.9% vs. 30%, p=0.02) compared with late imaging. Rates of urinary leak (3.5% vs. 8.6%, p=0.67) were similar. Early postoperative cystography was associated with reduced catheter duration (7 [6-10] vs. 10 [9-15] d, p<0.01) compared with no cystography. CONCLUSIONS: Despite having more high-grade injuries, early postoperative cystography was associated with reduced catheter duration and CAUTI rates without an increased urinary leak rate. Early imaging facilitates earlier catheter removal and improves outcomes. (J Trauma Acute Care Surg. 2026;000:000-000. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.