Bladder injury, particularly of a mechanical nature, is the most frequent major complication of gynecologic surgery, and can occur in other types of surgery or after trauma. Despite its frequency, there is limited research on best practices for bladder injury repair. This literature review aims to summarize types of iatrogenic bladder injuries, guidelines on bladder injury repair, expected follow-up care, and areas for further research. Literature review of societal guidelines, recent research, and expert opinions. This review is divided into 5 sections: types of bladder injury, pathophysiology of wound healing, repair techniques, indwelling catheter placement, post-operative care, and the special case of injury during sling placement. We discuss the classification of bladder injury. Iatrogenic bladder injuries are classified by the American Association of Surgery for Trauma Injury Severity Scale from grade 1-5 (Fig 1). Bladder injuries of grade 1 or 2 should be managed with prolonged drainage with indwelling urethral catheter for at least 7-14 days, although there is no consensus on duration. Injuries of grades 3 and higher require surgical management. Animal models for healing of the urothelium are reviewed. Surgical techniques for repair are summarized, followed by a review of current guidelines for post-operative care. American and European Associations of Urology guidelines recommend cystogram after conservatively treated bladder injuries and surgically repaired extraperitoneal injuries, but do not recommend it after surgical repair of simple intraperitoneal injuries. However, there is conflicting data on postoperative cystograms requiring further research. Lastly, special attention is granted to injury during bladder sling placement, a common gynecologic procedure. There is a consensus on types of bladder injury that need to be repaired surgically versus managed conservatively with an indwelling urinary catheter. There is also relative standardization in suture types used for surgical repair. Polyglactin 910 is the preferred suture to use for repair in one or two layers, depending on defect size. There are also standard guidelines for recognition and management of bladder injury during sling placement. However, more research is needed to determine duration of indwelling urinary catheter and the risk-benefit ratio of cystograms prior to catheter removal. Further studies should be designed with a larger sample size than what has been investigated in the available literature.View Large Image Figure ViewerDownload Hi-res image Download (PPT)