Bladder injuries associated with cesarean section
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: Objective: Identify the risk factors for bladder injury during cesarean section. Material and methods: A case-control study was conducted at INPerIER with women undergoing cesarean section from 1 January 2001 to 31 December de 2007. The cases were women who had experienced bladder injury during the procedure; two women per case were selected as controls, who underwent cesarean section without bladder injury during the same period. The medical charts were reviewed for analysis and comparison of the demographic and clinical characteristics. Results: Among the 24,057 cesarean sections, 21 bladder injuries were found (incidence 0.087%), of which only 19 were analyzed. Previous cesarean was more frequent among the cases than among the controls (63% vs 42% p 0.134), with an Odds Ratio (OR) of 2.35 (CI 95% 0.759- 7.319); the OR was 3.75 (CI 95% 1.002- 14.07) when a history of cesarean section was compared to no history at all. Statistically significant differences (p< .05) were found for: gestational age (38.16 vs 37.35 weeks), one previous cesarean (42% vs 18%), adhesions (79% vs 5%), VBAC (31.5% vs 3%), midline incision (16% vs 68%), Pfannenstiel incision (84% vs 32%), bleeding (744 cc vs 509 cc), and surgery time (135 vs 58 minutes), for cases with and without bladder injury, respectively. No significant differences were found in mother's age, BMI, prior surgery, preterm labor, premature rupture of membranes, height of the fetus, chorioamnioitis, pre-induction, uterine incision, urgency of the procedure, or uterine rupture. The presence of adhesions had an OR of 67.5 (CI 95% 11.14- 408).
Available from: lazraqinfo.com
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ABSTRACT: RESUME Les plaies vésicales sont des complications classiques de la chirurgie gynéco-obstétricale. Elles restent rares vu le nombre considérable d'interventions pratiquées. L'efficacité des traitements est directement proportionnelle à la précocité du diagnostic. Il s'agit d'une étude rétrospective, sur une période de 5 ans, de 20 cas de plaies vésicales d'origine gynéco-obstétricale. Nous avons relevé l'âge, les antécédents chirurgicaux, les types d'intervention gynéco-obstétricale, les types de lésions, les méthodes thérapeutiques pratiquées ainsi que les complications immédiates et tardives. L'âge moyen était de 40 ans et 5 patientes avaient un antécédent de césarienne. La plaie vésicale avait eu lieu dans 15 cas lors d'une césarienne et dans 5 cas lors d'une hystérectomie. Les lésions concernaient le dôme vésical dans 10 cas et la paroi postérieure dans 10 cas. La réparation des lésions vésicales s'est faite par voie exovésicale dans les lésions du dôme et par voie endovésicale dans les lésions de la paroi postérieure. Les suites opératoires étaient marquées par la survenue de fistules vésico-génitales chez 3 patientes, d'infections urinaires chez 2 patientes et d'un lâchage de sutures vésicales chez une patiente ayant nécessité une reprise chirurgicale. Les principaux facteurs de risque de survenue de plaies vésicales lors d'interventions gynéco-obstétricales sont les antécédents de chirurgie pelvienne, la parité et le volume utérin. La réparation par voie endovésicale est indiquée pour les lésions trigonales et sus-trigonales alors que la voie exovésicale est réservée aux lésions du dôme vésical. Le drainage des urines, pierre angulaire du traitement, se fait par une sonde urétrovésicale. L'évolution est en général bonne mais peut être grevée de complications à type d'infections urinaires ou de fistules vésico-génitales. Mots clés : plaies ; vessie ; chirurgie gynéco-obstétricale Correspondance : Dr. Y. AHALLAL. Bladder injuries are recognized complications in front of gyneco-obstetric surgery. Those injuries are relatively rare to the large number of interventions. The efficiency of conservative treatment is directly bound up with early diagnosis. A retrospective cases review of bladder injury during a time period of 5 years identified 20 bladder injury cases. Information was obtained on the women's age, the previous surgical history, the gyneco-obstetric interventions' types, the kinds of lesions, the therapeutic methods employed and finally the complications. The average woman age was 40 years old. 5 patients had a caesarean section antecedent. 15 bladder injuries happened during caesarean sections, and 5 during a hysterectomy. Half of the lesions were localised in the bladder anterior wall whereas the other half were localised in the bladder posterior wall. The fixing was made by a cystotomy for the bladder posterior wall lesions. The main surgical complications were urinary vaginal fistulas for 3 patients, urinary infections for 2 others and a suture desertion for one woman. The risk factors of bladder injuries during gyneco-obstetric surgery are mainly the patients' history of pelvic surgery, the parity and the size of the uterus. The fixing by cystotomy is relative when it comes to posterior bladder wall lesions. Bladder drainage by suprapubic or transurethral catheter is maintained on free flow for 10 days. The outcome is quite good in most of the cases, but it can be disturbed by complications such as urinary infections or vaginal fistulas.
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ABSTRACT: Lower urinary tract injury at the time of cesarean section is an uncommon complication. During a 5-year period, the incidence of bladder and ureter injuries at the Los Angeles County/University of Southern California Medical Center was .31 and .09%, respectively. When bladder injury occurs, it usually is due to surgical difficulty encountered while developing the bladder flap over the lower uterine segment. The difficulty is caused usually by scar tissue from previous surgery. Ureteral injury is a rare complication of cesarean section. It is attributable most often to ureteral transection or ligation associated with uterine incision extensions in the lower uterine segment or the vagina, and to attempts to achieve hemostasis. The data presented in this report indicate that cystotomy, when adequately repaired, is not associated with any complications. Furthermore, diagnostic cystotomy with intravenous injection of indigo carmine is a rapid, safe method of evaluating ureteral patency.
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