Bladder injuries associated with cesarean section.

The Journal of Urology (Impact Factor: 3.7). 01/1979; 120(6):762-3.
Source: PubMed

ABSTRACT Bladder injury during cesarean section is unusual and may occur by failure to empty the bladder preoperatively, inadequate bladder flap reflection or incision into the vagina rather than the lower uterine segment. Three bladder injuries during cesarean section are reported. Although 2 women recovered normally 1 has persistent vesicoureteral reflux. With liberalization of indications for cesarean section bladder injuries may be seen more frequently.

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    ABSTRACT: Injury to the maternal lower urinary tract is related to the standard of obstetric care and to different techniques utilized in delivery. In comparison with operative delivery, maternal urinary tract injury in association with vaginal delivery had always been exceptionally rare. However, with the recent progress in obstetric care and the introduction of new concepts such as vaginal delivery after caesarian section (VDAC), the pattern of maternal urological injuries associated with vaginal deliveries might have changed. In a retrospective study it was found that significant injuries to the lower urinary tract occurred in seven females in the course of vaginal delivery in the period between 1992 and 1994 in two major hospitals in the Riyadh area. These included rupture of the posterior bladder wall, trigone and bladder neck. Distal ureteric and urethral injuries, as well as bladder contusion were also encountered. Two patients developed vesico-uterine and vesico-vaginal fistulas. History of previous caesarian section was present in 4 patients. All deliveries were with cephalic presentation and six patients received oxytocin for induction or acceleration of labour. Episiotomy was done in 6 patients and instrumental delivery was performed in 3 patients. Gross haematuria immediately after delivery was the most common presentation, followed by urinary incontinence. Flank pain and fever were associated with ureteric injury and were delayed for few days. Urological injury should be suspected after vaginal delivery in females with previous caesarian section, if instrumental delivery is applied, and in patients with deep vaginal tears. The presence of gross haematuria, incontinence and flank pain should indicate full urological evaluation.
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