Incidence Of Bladder Injury Research Articles

Evaluation of the use versus nonuse of urinary catheterization during laparoscopic adnexal surgery: A randomized controlled trial

We conducted a randomized controlled trial to assess the feasibility and safety of performing gynecological single-port transumbilical laparoscopic-assisted adnexal surgery without urethral catheterization in a day surgery setting. A total of 153 patients with adnexal disease were enrolled in this prospective randomized controlled trial (RCT). All subjects performed single-port transumbilical laparoscopic-assisted adnexal surgery between March 2021 and July 2022 in a day surgery center. After completion of the baseline survey, participants were randomized into one of three groups. Participants were randomized into one of three groups: uncatheterized (n = 51), intermittent catheterized (n = 51), or indwelling catheterized (n = 51). The primary outcomes were the incidence of lower urinary tract symptoms (LUTS) and microscopic hematuria, and the secondary outcomes included the incidence of urinary tract infection (UTI), the incidence of urinary retention, the incidence of bladder injury, the time till first urination, the time till first ambulation, the time till first exhaust, the time till first feeding and Kolcaba comfort score. The incidence of postoperative LUTS in the uncatheterized group (17.65%) was lower than that in the intermittent catheterized group (52.94%) and the indwelling catheterized group (84.31%), and there was significant difference between the two catheterized groups (P < 0.001). In the patients without vaginal manipulation, the incidence of microscopic hematuria in the uncatheterized group (0%) was lower than that in the intermittent catheterized group (37.50%) and the indwelling catheterized group (38.89%) (P < 0.05). There were no significant differences in the first urination time, first ambulation time, first exhaust time, first feeding time, and comfort score among the three groups (P > 0.05). Moreover, no urinary retention, UTI and bladder injury were recorded in the three groups. Gynecological single-port laparoscopic adnexal surgery without urinary catheter is safe and feasible in a day surgery ward, which can reduce the incidence of postoperative LUTS and microscopic hematuria.

Management strategy for urologic morbidity in surgery of placenta accreta spectrum: stents or catheters?

Objective Surgery for placenta accreta spectrum disorders is known to be associated with urologic morbidity. Although previous studies have shown preoperative ureteral stent placement might be useful for preventing the urologic morbidity, the patient’s discomfort caused by it should not be ignored. Whether there is an alternative management strategy remains unknown. This study was to evaluate the effectiveness of ureteral stents and catheters in preventing urologic injury in patients with placenta accreta spectrum undergoing surgery. Methods We conducted a retrospective cohort study. All cases with diagnosed placenta accreta spectrum who underwent surgery at Peking University Third Hospital between January 2018 and December 2020 were collected and reviewed. They were divided into two groups according to the different management strategies for preoperative placement of ureteral catheters or stents. The primary outcome was urologic injury, which was defined as the presence of ureteral or bladder injury during and after surgery. Secondary outcomes included urologic complications within the first three months after surgery. The median (interquartile range) or proportions were reported for variables. The Man Whitney U test, chi-square test and multivariate logistic regression were used for analysis. Results Ultimately, 99 patients were included in this study. Ureteral catheters were placed in 52 patients and ureteral stents were placed in 47 patients. Placenta accreta, placenta increta, and placenta percreta were diagnosed in three, 19, and 77 women, respectively. The hysterectomy rate was 52.53%. Overall, urologic injuries occurred in three patients (3.03%), including one case of combined bladder and ureteral injury (1.01%) and two cases of bladder injuries (2.02%). Only one ureteral injury occurred in a patient with a ureteral stent, which was recognized postoperatively (p = .475). All bladder injuries were vesical rupture which were recognized and repaired intraoperatively; one patient in the catheter group and two patients in the stent group (p = .929). After adjusting for confounding variables, multinomial regression analysis revealed no significant differences between the two groups in the incidence of bladder injuries(aOR: 0.695, 95% CI: 0.035–13.794, p = .811). A lower risk of urinary irritation (aOR: 0.186, 95% CI: 0.057–0.605, p = .005), hematuria (aOR: 0.011, 95% CI: 0.001–0.136, p < .001), and lower back pain (aOR: 0.075, 95% CI: 0.022–0.261, p < .001) was found in patients with ureteral catheters than in those with ureteral stents. Conclusion The ureteral stents didn’t confer a protective benefit in the surgical management for placenta accreta spectrum compare with catheters; however, they did result in a higher incidence of postoperative urologic complications. Ureteral temporal catheters may be an alternative strategy for placenta accreta spectrum cases suspected with urinary tract involved prenatally. Moreover, clearly and explicitly reporting “double J stent” or “temporal catheter” is necessary for future researches.

The technique of intraoperative bladder filling to prevent surgical injuries of the urinary system during delivery in patients with placenta accrete

BACKGROUND: The annual increase in operative deliveries in obstetrics is steadily leading to an increase in the number of women with placenta accreta spectrum disorders. Cesarean section in patients with placenta accreta spectrum can be done only by surgeons of the highest qualification in operating rooms with the best technical equipment. Every year, the surgical delivery techniques for such patients get better and better, pursuing the goal of preserving the uterus and minimizing intraoperative complications and blood loss.&#x0D; AIM: The aim of this study was to assess the effectiveness of the intraoperative bladder filling technique during delivery in patients with placenta accreta spectrum.&#x0D; MATERIALS AND METHODS: All patients were randomly divided into two groups: 22 pregnant women (Group 1) who underwent caesarean section with metroplasty using intraoperative bladder filling technique and 19 pregnant women (Group 2) who underwent caesarean section with metroplasty without bladder filling. We analyzed the course of the operation, the measures taken to prevent blood loss, the time and scope of surgery, as well as surgical complications. Statistical analysis was performed using the non-parametric Mann-Whitney U-test and Fishers exact test.&#x0D; RESULTS: Patients of the both study groups were comparable in age, number of pregnancies in history, number of medical abortions, spontaneous abortions and non-developing pregnancies, as well as in the number of uterine scars in history. The total blood loss was 2177.8 114.9 ml in Group 1 and 2545.7 158.8 ml in Group 2 (p 0.05). Duration of surgery was 2 hours 45 7.1 minutes in Group 1 and 3 hours 31 4.1 minutes in Group 2. The bladder injury occurred in one patient in Group 1 in three patients in Group 2 (p 0.05).&#x0D; CONCLUSIONS: In patients with placenta accreta spectrum, the use of the bladder filling technique and mobilization of the bladder during cesarean section with metroplasty can reduce the percentage of intraoperative complications (incidence of bladder injury), intraoperative blood loss and the duration of surgery.

Use of ureteral catheter in uterine-sparing surgery for placenta accreta

Objective: The study aimed to investigate the effect of ureteral catheter use during surgery on the outcomes of obstetric and urinary complications in patients with placenta accreta spectrum (PAS) and placenta previa. Methods: The patients who were followed up at Meram Medical Faculty Hospital of Necmettin Erbakan University between January 2016 and November 2021 and diagnosed with PAS and placenta previa were included. Patients who underwent emergency and planned surgery were grouped as those with or without an intraoperative ureteral catheter. The primary outcome was determined as the rate of urinary system damage among these groups. The number of blood transfusions, preoperative and postoperative hemoglobin values and hemoglobin changes, length of hospitalization, patients who underwent uterine-sparing surgery or hysterectomy, urinary tract injury, and wound infection were compared regarding the use of catheters. Results: A total of 122 patients were included in the study. While an intraoperative ureteral catheter was placed in 56 (45.01%) patients, it was not used in 66 (54.09%) patients. Bladder injuries were determined in 31 (55.4%) patients with a catheter and 13 (19.7%) patients without a catheter, and no other urinary system injuries were found. The incidence of bladder injury was statistically significantly higher in the group with a catheter (p=0.001). The number of transfused erythrocyte suspensions, the hemoglobin change according to the preoperative hemoglobin level, and the mean duration of hospitalization in patients with a catheter were statistically significantly greater than the group without a catheter (p=0.001). Conclusion: Ureteral catheterization did not reduce urinary damage in patients with PAS and placenta previa who underwent uterine-sparing surgery and hysterectomy. However, we believe that the insertion of a catheter increases the possibility of diagnosing intraoperative damage.

Bladder Rupture Following Both Successful and Failed Trial of Labor After Cesarean [02L

INTRODUCTION: The incidence of bladder injury during cesarean section is estimated to be 0.08 to 0.94%. In patients with previous cesarean delivery, rate of bladder injury after successful VBAC is 0.2% while unsuccessful TOLAC confers 1.1% risk. The average length of bladder injury is 4.2 cm. METHODS: Case presentation. RESULTS: The first patient is a 26 year-old gravida 3 para 2 presenting at 39w3d in spontaneous labor with history of 31 week emergent cesarean for breech presentation at complete dilation. Labor augmented with oxytocin and patient progressed to complete. Successful vacuum-assisted delivery performed for fetal bradycardia. Approximately 90 minutes after delivery, patient was noted to have copious amounts of fluid from the vagina upon retrograde bladder fill. Exploratory laparotomy demonstrated posterior bladder rupture from dome to neck and anterior cervicovaginal rupture causing cervical avulsion. The second patient is a 34 year-old gravida 2 para 1 presenting at 38w6d in spontaneous labor with history of cesarean for failed vacuum delivery. Patient progressed to complete by own mechanism but opted for cesarean after 1 hour of pushing. After an atraumatic delivery of infant, entirety of Foley catheter was noted within surgical field. Large cystotomy present from posterior aspect of dome distally through trigone and bladder neck concurrent with uterine rupture demonstrating vaginal extension. CONCLUSION: Successful VBAC does not preclude urologic injury. TOLAC counseling should be individualized based upon prior operative reports, with high indices of suspicion when hysterotomy may have been performed lower than anticipated. With early recognition of injury, favorable prognosis can be achieved.

Laparoscopic radical hysterectomy has higher risk of perioperative urologic complication than abdominal radical hysterectomy: a meta-analysis of 38 studies

A meta-analysis was performed to assess risks of intraoperative and postoperative urologic complications in laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). We searched Pubmed, EMBASE, and Cochrane library for studies published up to December, 2018. Manual searches of related articles and relevant bibliographies of published studies were also performed. Two researchers independently performed data extraction. Inclusion criteria of studies were: (1) had information of perioperative complications, and (2) had at least ten patients per group. A total of 38 eligible clinical trials were collected. Intraoperative and postoperative urologic complications were reported by 34 studies and 35 studies, respectively. When all studies were pooled, odd ratios (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.40 [95% confidence interval (CI) 1.05-1.87]. The OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 1.01-1.80]. However, significant adverse effects of intraoperative urologic complications in LRH were not observed among articles published after 2012 (OR 1.12, 95% CI 0.77-1.62) in cumulative meta-analysis or subgroup analysis. The incidence of bladder injury was statistically higher than that of ureter injury (p = 0.001). In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. LRH is associated with significantly higher risk of intraoperative and postoperative urologic complications than abdominal radical hysterectomy.

Comparison of the Efficacy Between Transurethral Coagulation and Transurethral Resection of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients: A Prospective Randomized Controlled Trial

BackgroundInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by chronic pelvic pain related to the bladder with no effective treatment options. ObjectiveTo evaluate the efficacy and safety of transurethral resection (TUR) and transurethral coagulation (TUC) as treatments for Hunner lesion (HL) in IC/BPS. Design, setting, and participantsA single-center, prospective, randomized controlled trial involving 126 patients with HL in IC/BPS. InterventionTUR or TUC. Outcome measurements and statistical analysisPrimary outcome was recurrence-free time after surgery. Secondary outcomes included change of the number of frequency, nocturia, urgency episodes in voiding diaries, O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), pelvic pain and urgency/frequency (PUF) symptom scale, and visual analog scale (VAS) for pain and risk factors for recurrence. Results and limitationsThere were no differences in the recurrence-free time between treatment groups, a difference of 12.2 mo (95% confidence interval [CI], 11.1–17.6) for TUR, and a difference of 11.5 mo (95% CI, 9.03–16.1; p=0.735) for TUC. No difference was found in decreased mean daytime frequency, nocturia, urgency episodes, ICSI, ICPI, PUF symptom scale, and VAS for pain between both groups over 12 mo. Regardless of treatment types, there were significant improvements in all symptom questionnaires and pain compared with baseline (all, p < 0.05). Treatment type (TUR or TUC), age, sex, previous history of hydrodistension, and number of HLs did not affect recurrence. Incidence of bladder injury was higher in the TUR group (7.9%) than in the TUC group (3.4%). ConclusionsThere was no difference in the recurrence-free time and effect on urinary symptoms, including pain between TUC and TUR, for HL. Taking into account procedure-related complications, the surgeon can choose the method with which he/she is most familiar and comfortable. Patient summaryIn patients with bladder pain syndrome with Hunner lesions, both endoscopic resection and coagulation of the lesions are effective treatments.

Study on the complications of radical vaginal hysterectomy for locally bulky cervical cancer patients

Objective To analyze the complications of radical vaginal hysterectomy in patients with locally bulky cervical cancer. Methods All 258 patients of early cervical cancer (stage ⅠA2-ⅡA) selected in our hospital during the period of June 2011 to June 2016 undergoing radical vaginal hysterectomy and laparoscopic pelvic lymph node dissection were analyzed. All cases were divided into observation (locally bulky) and control (conventional) groups. Comparison analysis was performed for complications of the two groups and the influence of neoadjuvant chemotherapy on the complications of local bulky patients. Results The incidence of complications in the observation group was 26 cases (27.9%), higher than that in the control group of 28 cases (17.0%), the difference was statistically significant (P<0.05). The incidence of bladder injury (5 cases vs 2 cases) in observation group was significantly higher than that in control group (P<0.05). For patients with locally bulky early cervical cancer, the incidence rate of complications of the neoadjuvant chemotherapy group (15.8%) was significantly lower than the simple operation group (36.4%) (P<0.05). The incidence rate of ureteral injury in neoadjuvant chemotherapy group (0 cases vs 6 cases) was significantly lower than that in simple operation group (P<0.05). Conclusions Early cervical cancer patients with locally bulky (stage ⅠB2/ⅡA2) had higher incidence of complications of radical vaginal hysterectomy, and neoadjuvant chemotherapy can reduce the incidence of surgical complications. Key words: Hysterectomy, vaginal/AE; Uterine cervical neoplasms/SU/CO; Postoperative complications

Urologic injuries during gynecologic surgery, a 10-year review.

The study was conducted to evaluate the incidence of urologic injuries during gynecologic surgery, study the management and outcome of such injuries, and identify risk factors that may be associated with urologic injuries. A case-control study was conducted in patients who underwent gynecologic surgery from 2005 to 2014 in the university hospital. The study cases referred to patients who had urologic injury during gynecologic surgery and the control cases referred to patients who had gynecologic surgery matching the same period, type of procedure, and etiological disease leading to surgery. The medical records were reviewed and analyzed. Odds ratios (ORs) and 95% confidence intervals (CI) were used to identify risk factors associated with urologic injury. During the study period, there were 86 cases of urologic injuries from a total of 28 819 cases. The overall 10-year incidence was 0.30%. The incidence of bladder injury was 0.18%, (0.083% for ureteric and 0.014% for combined ureter and bladder injury). Among 80 cases with complete data, 52 (65%) had bladder injury and 48 (92.3%) were recognized the time of surgery and underwent primary repair with successful outcome, whereas 18 (75%) of 24 ureteric injury were detected intraoperatively. Previous pelvic surgery and the presence of adhesion were significant risk factors of urologic injury with OR 3.436, 95% CI 2.037-5.796 and OR 2.185, 95% CI 1.319-3.621, respectively. Urinary bladder injury was the most common urinary tract injury during gynecologic surgery. Previous pelvic surgery and the presence of adhesion were significant risk factors.

Incidence of Bladder Injury During Retropubic Midurethral Sling Placement After Prior Burch Colpopexy.

To elucidate if prior Burch changes the risk of bladder injury or rates of voiding dysfunction and continence in the immediate postoperative period when undergoing retropubic midurethral sling (MUS) placement. In this retrospective case control, charts were selected by Current Procedural Terminology codes for MUS placement. Women undergoing retropubic MUS placement with history of Burch urethropexy were considered. For every case, 2 age-matched and parity-matched controls without prior Burch were selected. In total, 538 charts were reviewed from 2010 to 2014. Twenty cases were found. There was a difference (P = 0.023) in trocar penetration of the bladder. Twenty-five percent (5/20) of women with prior Burch had a 9-fold (odds ratio [OR], 9.0; 95% confidence interval [CI], 1.0-82) higher chance of bladder penetration compared with women without prior retropubic surgery as calculated with Mantel-Haenszel paired test. Women with prior Burch had more success passing their voiding trials (OR, 7.5; 95% CI, 1.1-49.2). At 6 weeks, there was no difference in voiding dysfunction. Cure of stress incontinence at 6 weeks occurred more in controls than cases (P = 0.044) with match pairs manifesting an OR of 0.20 and 95% CI of 0.04-1.1. This study shows a significant increase risk of trocar penetration of the bladder during retropubic MUS placement in women with a history of Burch urethropexy. Despite this, MUS placement was successful in all women. Women with prior surgery were much more likely to pass their voiding trials. There was no difference in voiding dysfunction at 6 weeks between the 2 groups. This indicates that though bladder penetration with a trocar is more common in the setting of previous retropubic surgery, it does not impact a woman's short-term intraoperative or postoperative course.

Bladder Injury During Cesarean Delivery

INTRODUCTION: The incidence of bladder injury has been reported to be 0.27% for primary cesarean delivery, and 0.43%–0.81% for repeat cesarean delivery. Positively associated with bladder injury are adhesions from prior surgery, emergency delivery, labor during cesarean, and attempted vaginal birth after cesarean. We investigated bladder injuries during cesarean section, hypothesizing that most of the bladder injuries occurred during the second stage of labor. METHODS: We conducted an IRB-approved, retrospective study of cases in which women received bladder injuries during cesarean sections over the past fifteen years at a University-affiliated medical center. Statistical analysis was performed using descriptive analysis. RESULTS: At our institution, the incidence of bladder injury during cesarean delivery was 0.22% overall, 0.11% for primary cesareans, and 0.49% for repeat cesareans. Among 39 cases, 28 women (72%) were multiparous, while 26 (67%) were undergoing a repeat cesarean section. Of the 22 cases in which women were in labor, 15 (68%) were in the second stage. Of 39 bladder injuries, 21 (54%) occurred during urgent cesarean sections. 27 (69%) had adhesions. 35 cases were identified intraoperatively. CONCLUSION: Our study revealed that the majority of bladder injuries occurred in those patients who were multiparous, undergoing a repeat cesarean, had prior abdominal surgery and adhesions, were in labor, and underwent an urgent cesarean section. Of those in labor, the majority were in the second stage. Clinicians will be able to utilize this information to better manage their practices in attempt to avoid these injuries.

PL.75 An Audit of Lower Urinary Tract Injuries in a Large Obstetric Unit – 2 Year Outcome

ObjectiveThe main objective of this audit was to investigate the number of bladder injuries after delivery and compare it to the existent incidence in literature.MethodRetrospective medical record review of patients...

Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series

The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited cases in which the bladder was perforated by the suprapubic trocar. Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars. Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.

Obesity and the incidence of bladder injury and urinary retention following tension-free vaginal tape procedure: retrospective cohort study.

Background/Aims. Aim of the study was to establish an effect of obesity on the incidence of bladder injury or urinary retention following tension-free vaginal tape (TVT) procedure. Methods. This was a retrospective cohort study based at the Norfolk and Norwich University Hospital in the UK. Study population included 342 cases of TVT procedures. Incidence of bladder injury was 4.7% (16/342). Rate of urinary retention was 9% (31/342). Body mass index (BMI), age, type of analgesia, concomitant prolapse repair, and previous surgery were factors studied. Univariate analysis was performed to establish a relationship between BMI and complications, followed by a multivariable regression analysis to adjust for age, concomitant surgery, type of analgesia, and previous surgery. Results. Neither univariate analysis nor multivariate regression analysis revealed any statistically significant influence of obesity on the incidence of bladder injury or urinary retention. Unadjusted odds ratios and adjusted odds ratios for bladder injury and urinary retention by BMI groups were OR 1.7296 CI 0.4818–6.2097; OR 1.3745 CI 0.5718–3.3043 and adj. OR 2.885 CI 0.603–13.8; adj. OR 1.299 CI 0.502–3.365. Conclusion. Obesity does not appear to influence the rate of bladder injury or urinary retention following TVT procedure.

Safety and efficacy of the transobturator tape for stress urinary incontinence: short-term and medium-term results of 125 patients demonstrate a procedure-related learning curve

Our aim was to assess the safety and efficacy of the transobturator tape (TOT) for the surgical treatment of female stress urinary incontinence. We report our initial experience in a district general hospital and study the learning curve effect. This is a retrospective study of the first 125 women to have the TOT procedure (Aris® Transobturator Tape). Short-term follow-up took place with the operating gynecologist in the clinic 3 months postoperatively, while medium-term follow-up was assessed by a patient questionnaire at 18–36 months (mean 23 months). Short-term success rate was 89.3%. Complications were bladder injury 2.4%, postoperative urinary tract infection 8.1%, transient voiding dysfunction 13.7%, tape erosion 4.1%, and de novo urgency 14%. Questionnaire response rate was 66%. Subjective cure at 18–36 months was 81.5% with 88.9% reporting an improvement in quality of life. Ten women underwent repeat TOT after primary procedure failure with 80% success. Tape erosion occurred up to 17 months postoperatively, thus overall incidence was 6.4%. The incidence of bladder injury, tape erosion, and tape failure was higher in the first 60 patients, thus we performed an analysis of these events by the number of procedures performed and demonstrated a definite learning curve. The TOT is a safe and effective surgical treatment for stress urinary incontinence; however, as for all new surgical procedures, there exists a learning curve.

Bladder Injuries During Cesarean Section in a University Hospital: A 25-Year Review

In the past 40 to 50 years, a steady increase in the incidence of cesarean section (CS) worldwide has stimulated interest in complications associated with CS. One such complication, bladder injury, occurs infrequently with a reported incidence of less than 1%. This retrospective study investigated the incidence of bladder injury during CS, and identified risk factors associated with injuries, as well as discussing potential means of prevention, suggested management, and ultimate outcome. Review of medical records of 67,618 deliveries between 1983 and 2007 at a hospital in Saudi Arabia identified 7708 patients (11.4%) delivered by CS. Demographic and clinical data assessed included number of prior cesarean deliveries and previous pelvic surgery, elective or emergency procedure, presence of adhesions, location and size of the bladder injury, diagnosis, management, and outcome. Among the 7708 CS deliveries, 34 cases of bladder injury were identified (overall incidence: 0.44%). More bladder injuries were found among women with repeat CS (58.6%) than those with primary CS (41.4%) with an incidence of 0.81% and 0.27%, respectively (P < 0.0014). During surgery, there was a significant association between occurrence of bladder injury and separation of the bladder flap over the lower uterine segment (P < 0.024) and previous CS, other pelvic surgery and presence of adhesions (P < 0.0006). Surgeons recognized all bladder injuries intraoperatively and made immediate repairs resulting in an overall satisfactory outcome. Bladder injury occurred more frequently with emergency CS (64.3%) than elective CS (35.7%) (P < 0.024). These data show that optimal outcomes for bladder injuries occurring during CS are associated with early recognition of the injury and adequate repair. Patients with a history of multiple CS are at significant risk for bladder injury.

Bladder Injury Mimicking Acute Renal Failure After Cesarean Section

The reported incidence of bladder injury after cesarean section ranges from 0.14% to 0.94%. Most of the injuries were found intraoperatively. Delayed presentation is rare. We report a patient with bladder perforation presented with 'acute renal failure' and ascites 14 days after an uneventful cesarean section. Her clinical picture and initial presentation mimicked those of ureteric injury. Conventional cystography failed to demonstrate the bladder perforation. Computed tomography cystography clarified the diagnosis. Subsequent laparoscopic bladder repair resulted in quick and smooth recovery. This case highlights the pitfall of conventional cystography and the successful use of laparoscopy in management of this urologic condition. Literature was reviewed for this condition and its management.

Urological injuries during hysterectomies: A 6‐year review

Urological injuries that occur during hysterectomy are a rare but important cause of morbidity. An understanding of the risk factors can help us to reduce their incidence and studying their management and outcome could help us to evolve optimal management strategies. The aim of the present study was to examine the incidence of urological injuries that occur during hysterectomy and to determine the risk factors, management and outcome of such injuries. A retrospective analysis of cases of urological injuries sustained during hysterectomies carried out from June 1996 until May 2002, at our institution. The chi-squared test was applied for statistical analysis. The overall incidence of urological injuries was 0.40% (0.28% bladder and 0.12% ureteral). No ureteral injuries occurred during vaginal surgery. The incidence of bladder injury was significantly higher in non-descent vaginal hysterectomies compared with abdominal hysterectomies or vaginal hysterectomies for genital prolapse (P<0.05). Hysterectomy for ovarian malignancies had a significantly higher risk for bladder injuries compared with other indications. Bladder injuries detected during vaginal hysterectomies could be managed through the vaginal route. All the repairs healed successfully. Non-descent vaginal hysterectomy and hysterectomy for ovarian malignancies have a higher risk of bladder injury. Urological injuries during hysterectomy are uncommon. Early detection and appropriate management ensure successful healing and minimal long-term sequelae.

Bladder Injury During Laparoscopic Surgery

The objective of this review is to present the incidence of iatrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

Urinary Tract Injuries After Hysterectomy

Objective: To evaluate the nationwide incidence and characteristics of urinary tract injuries after laparoscopic hysterectomy, total abdominal hysterectomy, supracervical abdominal hysterectomy, and vaginal hysterectomy. Methods: We analyzed retrospectively 142 urinary tract injuries after hysterectomy, reported to the National Patient Insurance Association in Finland from 1990 through 1995. The Finnish Hospital Discharge Register collects data on procedures from all hospitals, and 62,379 hysterectomies were carried out during the study period. Results: The total incidence of ureteral injury after all hysterectomies was 1.0 of 1000 procedures: 13.9 of 1000 after laparoscopic, 0.4 of 1000 after total abdominal, 0.3 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a ureteral injury were encountered in 51%, 76%, 100%, and 100%; the failure rates of primary repair of a ureteral injury were 5%, 12%, 0%, and 0%; and the convalescence times after a ureteral injury were 86 days, 94 days, 71 days, and 47 days after laparoscopic, abdominal, supracervical abdominal, and vaginal hysterectomies, respectively. The incidence of bladder injury was 1.3 of 1000 procedures. Sixty-five percent of reported bladder injuries were fistulas, giving an incidence of vesicovaginal fistula of 0.8 of 1000 procedures after all hysterectomies: 2.2 of 1000 after laparoscopic, 1.0 of 1000 after total abdominal, 0 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a bladder injury were encountered in 53%, 37%, 100%, and 0%; the failure rates of primary repair of a simple bladder injury were 5%, 18%, 0%, and 0%; the failure rates of primary repair of a vesicovaginal fistula were 17%, 20%, 0%, and 0%; and the convalescence times after a bladder injury were 51 days, 118 days, 71 days, and 99 days after laparoscopic, abdominal, supracervical abdominal, and vaginal hysterectomy, respectively. Conclusion: The risk of ureteral injury is higher after laparoscopic hysterectomy compared with traditional hysterectomies.