Bladder Injury Research Articles

Genito-Urinary Trauma in the War Context: A Review of Two Decades of Experience From the French Armed Forces.

In recent conflicts, injuries to urogenital organs ranged from 5 to 7.2% of all combat-related injuries. Open surgery remains the main approach in combat settings, and in the French military, urgent surgical procedures are mostly performed by general surgeons with no specialization in urological care. To explore the specific needs in advanced surgery courses, we aimed to describe the epidemiology and management of genito-urinary traumas in recent conflicts in French Medical Treatment Facilities (MTFs). Data were extracted from the OPEX® registry, which prospectively recorded surgical activity from 2001 to 2021. All patients treated in French Role 2 Enhanced or 3 MTFs requiring emergency surgery for urogenital injury were included. The mechanism of trauma, type of genito-urinary injury (GUI), and surgical management were reported. After screening, a total of 4,603 patients were admitted for emergency or delayed emergency surgery. Among them, 31 (0.67%) patients had urogenital injuries requiring immediate management. Most injuries were combat-related (77.4%), caused by gunshots (45%) and explosions (29%). Ten patients (32%) were hemodynamically unstable at initial management. Bladder and testicular injuries were the most common (12 [39%] and 8 [25.8%], respectively). Kidney injuries were rare but led to organ extirpation in 60% of the cases. Associated digestive injuries occurred in 45.2% of the cases. All procedures used the open approach. This study is the first to examine genito-urinary traumas in overseas operations during French army deployments. The results highlight the relatively low incidence of urological trauma, with most injuries involving the bladder and testis. Our findings highlight the importance of equipping military surgeons with the skills necessary to manage complex cases.

SPHK1/S1PR1/PPAR-α axis restores TJs between uroepithelium providing new ideas for IC/BPS treatment.

Interstitial cystitis/bladder pain syndrome (IC/BPS) represents a chronic, aseptic inflammatory bladder condition with an unclear etiology and few therapeutic options. A composite barrier structure composed of the uroepithelium and glycosaminoglycan layer forms on the bladder's inner surface to block urine and other harmful substances. Dysfunction of this barrier may initiate the pathogenesis of IC/BPS. Sphingosine-1-phosphate (S1P) plays a crucial role in forming tight junctions. Perfusion of S1P into the bladder restored uroepithelial tight junctions in mice with cyclophosphamide-induced acute cystitis and ameliorated symptoms of the lower urinary tract. Mice lacking sphingosine kinase 1 (SHPK1) exhibited more severe bladder injuries and dysfunction. Concurrent in vitro experiments elucidated S1P's protective effects and its role as a primary messenger through SPHK1 and S1P receptor 1 (S1PR1) knockdown. This study identifies a novel mechanism whereby S1P binding to S1PR1 activates the PPAR-α pathway, thereby enhancing cholesterol transport and restoring tight junctions between uroepithelial cells. These findings elucidate the regulatory role of S1P in the bladder epithelial barrier and highlight a promising therapeutic target for IC/BPS.

Clinical Characteristics Related to Complications in Abdominal Gynecological Surgery

Background: Gynecological conditions account for a significant number of surgical procedures performed worldwide, with complication rates reported between 0.2-34%. In Mexico, complication rates range from 2.15% to 15.06%. Factors such as age, obesity, comorbidities (hypertension, diabetes), and prolonged surgical time are associated with a higher risk of complications, including postoperative infections. Objective: To determine the clinical characteristics related to complications in abdominal gynecological surgery. Materials and Methods: A retrospective, descriptive, cross-sectional, and analytical study was conducted on women undergoing scheduled surgery by the Gynecology service at the Hospital de Ginecoobstetricia UMAE-CMNO IMSS during the period from January 2023 to December 2023. The study aimed to determine the frequency of postoperative complications and their relationship with clinical characteristics. The sample size calculation used the proportion formula and finite population, requiring a minimum sample of 156 patients. However, all gynecological surgeries performed during the study period were included. After obtaining approval from the Local Research Committee in Health 1310, data was collected from the hospital’s surgical productivity registry platform. Surgical data was obtained from both electronic and physical clinical records to identify postoperative complications. The data collection tool was entered into a Microsoft Excel database, and statistical analysis was performed using IBM SPSS (version 30.0). Results: A total of 392 patients were included in the study. Among them, 78 patients (19.9%) experienced complications. The most common complication was hemorrhage (9.2%), followed by wound dehiscence (3.6%), bladder injury (3.1%), surgical wound infection (2.6%), fever (1.5%), vaginal dome hematoma (1.0%), intestinal injury, and urinary tract infection (both at 0.8%), paralytic ileus (0.3%), along with other complications such as vascular injury and death (0.3%). When analyzing the groups, it was found that patients in the complication group had a higher Body Mass Index (BMI) compared to those without complications. Additionally, the surgical time, estimated bleeding, and hospital stay days were significantly higher in the complication group. Both groups showed similar characteristics in terms of age, parity, prior abdominal surgeries, comorbid conditions, smoking, ASA risk classification, and preoperative hemoglobin levels. Conclusions: The frequency of postoperative complications in this study aligns with findings reported in most international studies, with hemorrhage being the most common complication. BMI was significantly associated with a higher risk of complications, including bleeding, need for transfusions, and prolonged surgical times.

MRI Signs Associated With Bladder Injury During Cesarean Delivery in Severe Placenta Accreta Spectrum Disorders.

Bladder injury during cesarean delivery (CD) in pregnant women with severe placenta accreta spectrum (PAS) disorders mostly occurs in the dissection of vesico-uterine space. Placental MRI may help to assess the risk of bladder injury preoperatively. To identify the high-risk MRI signs of bladder injury during CD in women with severe PAS. Retrospective. One hundred sixty-seven women with surgically confirmed severe PAS, defined as to increta or percreta, who underwent planned CD and available placental MRI. 1.5 Tesla, half-Fourier single-shot turbo spin echo sequence and true fast imaging with steady state free precession sequence. Presence of following imaging features of the vesico-uterine region were independently evaluated by three radiologists (with 8, 8, and 15 years of experience, respectively): vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line, bladder wall interruption with hyperintense nodularity, bladder tenting, and uterine-placental bulge. Univariable analyses (Chi-square or Fisher's exact test) and multivariable regression analyses were used. A P value <0.05 was considered significant. Thirty-three of the women (19.8%) experienced bladder injury during CD. MRI features were significantly more frequent in the bladder injury group compared with the no bladder injury group: 69.7% vs. 26.9% in vesico-uterine space hypervascularity, 57.6% vs. 21.6% in absent chemical shift line in the vesico-uterine space, 18.2% vs. 1.5% in bladder wall interruption with hyperintense nodularity, 39.4% vs. 14.9% in bladder tenting, and 78.8% vs. 39.6% in uterine-placental bulging. Vesico-uterine space hypervascularity, absent chemical shift line, and uterine-placental bulge were independently associated with the risk of bladder injury (odds ratios: 4.190, 3.555, and 3.569, respectively). Vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line and uterine-placental bulge were associated with bladder injury during CD in women with severe PAS. Bladder injury is a serious complication of cesarean delivery in pregnant women with severe placenta accreta spectrum, frequently resulting in massive hemorrhage, bladder dysfunction and severe infection. Accurate prenatal assessment is important to minimize these adverse consequences. This study showed that MRI features, including vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line and uterine-placental bulge, were independently associated with bladder injury. These high-risk MRI signs may serve as effective means for prenatal assessment of bladder injury. This study would broaden the application of MRI in severe placenta accreta spectrum. 3 TECHNICAL EFFICACY: Stage 2.

Recent advances in innovative biomaterials for promoting bladder regeneration: processing and functionalization.

The bladder is a dynamic organ located in the lower urinary tract, responsible for complex and important physiological activities in the human body, including collecting and storing urine. Severe diseases or bladder injuries often lead to tissue destruction and loss of normal function, requiring surgical intervention and reconstruction. The rapid development of innovative biomaterials has brought revolutionary opportunities for modern urology to overcome the limitations of tissue transplantation. This article first summarized the latest research progress in the processing approaches and functionalization of acellular matrix, hydrogels, nanomaterials, and porous scaffolds in repairing and reconstructing the physiological structure and dynamic function of damaged bladder. Then, we discussed emerging strategies for bladder regeneration and functional recovery, such as cell therapy, organoids, etc. Finally, we outlined the important issues and future development prospects of biomaterials in bladder regeneration to inspire future research directions. By reviewing these innovative biomaterials and technologies, we hope to provide appropriate insights to achieve the ultimate goal of designing and manufacturing artificial bladder substitutes with ideal performance in all aspects.

Urinary Catheter Causing Paracentesis-induced Circulatory Dysfunction.

A 78-year-old male was admitted to the hospital due to acute-on-chronic liver failure with spontaneous bacterial peritonitis. About six liters of a yellow, turbid fluid were collected via indwelling urinary catheter (UC) overnight. He subsequently developed neurological and cardiac dysfunctions. Imaging confirmed bladder perforation and intraperitoneal placement of the UC, establishing the diagnosis of paracentesis-induced circulatory dysfunction due to unintended ascitic fluid drainage. He was stabilized with albumin replacement. The UC was removed, and the bladder injury resolved spontaneously. This case depicts a rare complication of urinary catheterization, which underscores the need for careful monitoring and prompt intervention to effectively manage unexpected catheter-related issues.

INTRAVESICAL FOREIGN BODIES MIMICKING BLADDER CALCULI: A CASE REPORT

Objective: In this case report, we will present a patient with an intravesical foreign body mimics bladder calculi. Case(s) presentation: A 37-year-old man presented with pain in the suprapubic area. The patient had a history of several urological procedures. First, at the age of 11 years, He had an augmentation cystoplasty due to a congenital neurogenic bladder. Later, at the age of 15 and 20, He experienced two traumatic bladder ruptures requiring open repair, and the Mitrofanoff appendicovesicostomy for intermittent self-catheterization was performed. Discussion: The patient underwent an emergency cystoscopy that revealed calcified cut ends of four urethral catheter tips. Cystolitholapaxy was performed to crush these calcified foreign bodies facilitating cystoscopic removal. Conclusion: A 37-year-old man presented with intermittent suprapubic pain caused by intravesical foreign bodies. Hence, Cystolitholapaxy was performed to remove these calcified foreign bodies. The patient was observed and discharged from the hospital after seven days of treatment. Keywords: Bladder, foreign bodies, suprapubic pain, vesica urinaria.

Modified surelift anterior-apical transvaginal mesh for advanced urogenital prolapse: Retrospective surgical, functional and sonographic outcomes at 3 years

ObjectiveThis study evaluates the outcomes of modified transvaginal mesh (TVM) Surelift in managing advanced pelvic organ prolapse (POP) over a 3-year follow-up period, focusing on surgical success, functional improvement, and sonographic findings. MethodsA retrospective review was conducted on 99 women who underwent Surelift System surgery for advanced POP Stage III and IV between July 2018 to January 2020. Objective evaluation included Pelvic Organ Prolapse Quantification (POP-Q), multichannel urodynamic (UDS), and introital 2D ultrasonographic measurement. Subjective evaluation uses validated questionnaires of Incontinence Impact Questionnaire-7(IIQ-7), Urogenital Distress Inventory-6(UDI-6), Pelvic Organ Prolapse Distress Inventory 6(POPDI-6), Colorectal Anal Distress Inventory-8(CRADI-8) and Pelvic organ prolapse/ Urinary Incontinence Sexual Questionnaire (PISQ-12). Outcomes were examined at 3 months, yearly and at 3 years postoperative. Secondary outcome included de novo or persistent urodynamic stress incontinence (USI) and surgical complications. ResultsEighty-five women were included in the final analysis. At 3 years postoperative, the objective cure rate was 94.1 % and subjective cure rate of 91.8 %. Ultrasonography revealed initial mesh elongation and thickening at first year, resolving by the third year, while the distance between the bladder neck and mesh remained stable. Significant improvement in POP-Q components (Aa,Ba,C,Ap,Bp and TVL of p < 0.001), UDS (p < 0.001) and all validated Quality of Life (QoL) questionnaires (p < 0.001) were seen. De Novo USI and persistent USI occurred in 31.5 %. Complications included vaginal mesh exposure requiring excision in 4.7 % of patients, and one intraoperative bladder injury corrected promptly. ConclusionThe Surelift System TVM demonstrates safety and efficacy in treating advanced anterior-apical POP, achieving high cure rates, secured mesh placement, and minimal complications at 3 years post-operative.

The Autologous Fascial Pubovaginal Sling for Recurrent Stress Incontinence: A Retrospective Study.

This study aimed to analyze the clinical efficacy and safety of autologous fascial pubovaginal sling (AFPVS) surgery in treating recurrent stress urinary incontinence (SUI) following the failure of mid-urethral sling procedures. A retrospective analysis was conducted on the clinical data of SUI patients who underwent AFPVS at our hospital between 2008 June and 2024 June following the failure of mid-urethral sling procedures. The analysis included basic information, surgical parameters, and postoperative complications. Additionally, telephone interviews using the International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF) and the Incontinence Quality of Life Questionnaire (I-QOL) was conducted at 6-month follow-up. Thirty-four patients with the mean age of 54.8 ± 15.7 years old were reviewed, and the median disease duration was 3 (2-10) years. Of the 34 patients, 20 (58.8%) were cured, 8 (23.5%) showed improvement, resulting in an overall effectiveness rate of 82.3%. Three cases experienced bladder injury, which resolved after 2 weeks of catheterization, but no patients had urethral or vaginal injuries intraoperatively. Postoperative scores on the ICI-Q-SF significantly decreased (p < 0.001), and postoperative I-QOL scores significantly increased (p < 0.001) compared to preoperative scores. AFPVS is a safe and effective salvage procedure for recurrent SUI following the failure of mid-urethral sling procedures.

Massive bladder herniation: an interesting case of scrotal cystocele with bowel herniation

Inguinal bladder herniation is a commonly seen clinical entity which represents 1–4% of all inguinal hernias. However, the extensive inguinoscrotal herniation of the bladder, known as scrotal cystocele, is very rare. Clinical findings can vary from asymptomatic findings to surgical emergencies. Radiographic imaging can play important role in the diagnosis to reduce the risk of bladder injury during hernia repair when urinary symptoms are present. Computed Tomography scan is a gold standart to identify the hernia sac. Computed tomography findings observed in axial planes, should also be carefully evaluted in other planes. Sagittal or coronal images may provide better evaluation of the hernia and its relationships with surrounding tissues. The standard treatment of inguinal bladder hernaiation is either reduction or resection of the herniated bladder followed by hernia repair. This case describes a systematic approach and role of computed tomography in the diagnosis of inguinal bladder hernaiation.

Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis.

In recent years, the management of placenta accreta spectrum (PAS) has fallen into two categories: planned hysterectomy and conservative management to preserve fertility. However, optimal management remains unclear. Therefore, we conducted a systematic review and meta-analysis comparing the two to evaluate which approach was associated with lower surgical morbidity. MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from inception to July 31, 2023, for trials comparing conservative management versus planned hysterectomy. We included all prospective or retrospective cohort studies, case-control studies, and randomized control studies that reported outcomes related to surgical morbidity in cases of PAS. Surgical morbidity was defined as rates of intensive care unit (ICU) admission, disseminated intravascular coagulation (DIC)/coagulopathy, bladder injury, number of units of packed red blood cells (PRBCs) transfused, estimated blood loss (EBL), and maternal mortality. Odds ratios (ORs) were computed with 95% confidence intervals (CIs) using a fixed or random effects model. Among 839 studies initially retrieved, 12 were included with a total of 1,167 patients. Of these, 669 (57.3%) underwent conservative management and 498 (42.7%) underwent a planned hysterectomy. Conservative management resulted in lower rates of ICU admission (OR = 0.11; 95% CI: 0.04, 0.35), lower rates of bladder injury (OR = 0.31; 95% CI: 0.2, 0.48), lower incidence of DIC or coagulopathy (OR = 0.22; 95% CI: 0.10, 0.48), lower mean difference EBL (-1,292.81 mL; 95% CI: -1,922.16 to -593.46), as well as lower number of PRBC units transfused (-1.54 units; 95% CI: -2.29 to -0.78). Our findings suggest that conservative management of PAS may be associated with reduced surgical morbidity. · management of PAS has fallen into two categories: planned hysterectomy and conservative management.. · Optimal management for PAS remains unclear.. · conservative management of PAS may be associated with reduced surgical morbidity..

Adult Bladder Trauma Management

Bladder injuries occur in up to 10% of abdominal trauma cases, contributing to significant morbidity and mortality (10–22%). These injuries may result from blunt or penetrating trauma, as well as iatrogenic damage during surgical procedures. Accurate diagnosis and timely intervention are crucial to minimizing complications. Bladder injuries are classified into extraperitoneal (EP), intraperitoneal (IP), or combined types. Mechanisms of injury vary, with blunt trauma, predominantly from motor vehicle accidents, accounting for 60–85% of cases, and penetrating injuries, such as gunshot wounds, comprising 15–51%. Evaluation includes clinical assessment, cystography, and CT imaging, supplemented by cystoscopy for iatrogenic cases. Management strategies range from conservative catheterization to surgical repair, depending on injury type and severity. EP injuries, the most common type (63%), are frequently associated with pelvic fractures, whereas IP injuries (32%) typically result from blunt trauma to a distended bladder. Conservative management with catheter drainage suffices for most EP injuries; however, IP injuries necessitate surgical intervention to mitigate risks such as sepsis and peritonitis. Outcomes are influenced by concomitant injuries, which are often more critical than the bladder injury itself. Advanced imaging modalities, particularly CT cystography, offer high sensitivity and specificity for bladder injury diagnosis. While conservative management is preferred for minor injuries, indications for surgical repair include significant extravasation, ongoing urinary leakage, or associated injuries. Multidisciplinary approaches are essential for comprehensive trauma care. Bladder injuries are rare but carry substantial risks if unrecognized or inadequately treated. Timely diagnosis, guided by clinical suspicion and imaging, coupled with appropriate management strategies, is essential to optimize outcomes and reduce complications.

Case report: Preputial tube-flap ureteroplasty for neoureter creation in a male dog with post ureterocolonic anastomosis complications

A 16.50 kg, 5-year-old male mixed breed dog presented due to complications following a ureterocolonic anastomosis performed to manage of ureteral and urinary bladder injuries. The first revision surgery involved reimplantation of the ureters into the cranial aspect of the prepuce. Dehiscence of the anastomosed ends of the right ureter was observed postoperatively. A second revision surgery was then performed, involving a preputial tube-flap ureteroplasty via preputiotomy. A longitudinal flap was raised from the prepuce and anastomosed to the end of the right ureter to create a neoureter and reduce tension at the anastomosis site. Postoperative follow-up evaluations at 10 days and 6 months revealed no unexpected complications. Six months follow-up, the owner reported that the dog exhibited a satisfactory quality of life.

Efficacy of Sandwich Technique (Balloon Tamponade and Compression Suture) in Cases of Placenta Previa and Accreta

Objective: To assess Sandwich Balloon Technique (SBT) efficacy in cases of Placenta Previa (PP) and Placenta Accreta (PA) as uterine conserving hemostatic method in Caesarean Sections. Methodology: This quasi experimental study was carried out in cases of PP and PA employing SBT (compression suture + balloon tamponade) as a uterine conserving method, in a tertiary care hospital of Karachi from 1st July 2022 till 31st December 2022. Outcome measures including blood loss during surgery, intra-operative blood transfusions, post-operative complications, balloon tamponade removal time, post-operative hospital stay and hysterectomy were recorded. Descriptive statistics were analyzed by means of SPSS 22. Results: Out of 50 patients, 34(68%) had PP and 16(32%) PA. Mean blood loss 972±474ml; mean blood transfusion1.8±1.37units, balloon tamponade removal time in 24 hours 52% and in 48 hours 38%, average hospital stay 3.44±1.64 days, failure resulting in hysterectomy in five patients (10%) and complications including fever, haemorrhage, wound infection and bladder injury in 11 (22%) patients. There was no case of delayed hemorrhage, significant maternal morbidity or mortality. SBT was 100% effective in controlling hemorrhage in cases of PP and 68.8% in cases of PA. Conclusion: SBT is a safe, feasible, effective hemorrhage controlling method for PP and PA cases and is extremely beneficial uterine conserving technique.

Surgical outcomes of single-port vs multi-port laparoscopic hysterectomy for endometrial cancer: A systematic review and meta-analysis.

This study aimed to compare the surgical outcomes in patients with endometrial cancer who underwent either single-port laparoscopic hysterectomy (SPLH) or multi-port laparoscopic hysterectomy (MPLH). We conducted a systematic literature search from the earliest records available up to May 2023. The databases searched included PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library. A total of 12 studies were included in the analysis. Both the SPLH and MPLH groups had similar operative times (MD = -4.27, 95% CI [-35.75, 27.22], p = 0.98), conversion rates (odds ratio [OR] = 1.43, 95% CI [0.57, 3.59], p = 0.44), blood transfusion rates, intraoperative complications (bladder injury, bowel injury, and vascular injury), and postoperative complications (umbilical hernia, fever, fistula, lymphocyst, and wound-related issues). However, the SPLH group showed significant advantages in certain areas. There was a notable reduction in estimated intraoperative blood loss (EBL) compared to the MPLH group (mean difference [MD] = -23.80, 95% CI [-42.99, -4.62], p = 0.02) and a shorter hospital stay duration (MD = -0.33, 95% CI [-0.46, -0.20], p < 0.00001). Although there was some debate about postoperative pain, SPLH tended to have more favorable outcomes. Despite these advantages, the SPLH group was less efficient in para-aortic lymph node clearance compared to the MPLH group (MD = -0.96, 95% CI [-1.57, -0.35], p = 0.002). No significant differences were observed in overall lymph node dissection (MD = -0.91, 95% CI [-2.52, 0.70], p = 0.27) and pelvic lymph node dissection (MD = -1.22, 95% CI [-3.82, 1.27], p = 0.36) between the two groups. Additionally, both groups showed similar therapeutic results, with no significant differences in overall survival (OS) and progression-free survival (PFS). SPLH and MPLH techniques are equally effective in treating endometrial cancer, with both showing low rates of surgical complications with similar rates of surgical complications and therapeutic outcomes. However, SPLH offers additional benefits, including smaller incisions, reduced estimated intraoperative blood loss, and shorter hospital stays, making it an increasingly popular option for treating endometrial cancer.

Comparative Analysis of da Vinci® Xi and hinotori™ SRS Robot-Assisted Surgery Systems for Gynecologic Disorders: A Retrospective Study.

Background and Objectives: This study aims to evaluate and compare the safety and efficacy of the da Vinci® Xi and hinotori™ SRS robot-assisted surgical systems for gynecologic disorders. Materials and Methods: We conducted a retrospective study of 401 cases (43 benign uterine tumors; 88 pelvic organ prolapses; 270 low-risk endometrial cancers) of robot-assisted surgery performed at Kagoshima University Hospital between January 2017 and October 2024. Surgical factors such as the operative time, blood loss, and complication rates were analyzed and compared between the da Vinci® Xi (332 cases) and hinotori™ SRS (69 cases) systems. Complications were classified according to the Clavien-Dindo classification, with Grade 2 or higher considered significant. Results: Significant differences were observed between the two groups in terms of age, body mass index, cockpit/console time, and median time from roll-in to cockpit/console start. The cockpit/console time was significantly longer for the hinotori™ SRS system (173 min) compared to the da Vinci® Xi (156 min; p = 0.047). No significant differences were observed in the total operative time, blood loss, or length of hospital stay. Intraoperative complications were minimal, with one case of bladder injury and one case of vascular injury recorded for the da Vinci® Xi. The overall postoperative complication rate was approximately 4%. Conclusions: Robot-assisted surgery using both the da Vinci® Xi and hinotori™ SRS systems was found to be safe, with minimal blood loss and a low complication rate. The hinotori™ SRS system demonstrated operative outcomes comparable to those of the da Vinci Xi® system, suggesting that it may serve as a viable alternative. Further prospective studies are warranted to evaluate the efficacy and safety of these systems.

Risks and Outcomes of Uterine Rupture in Women With and Without a Trial of Labour

ObjectivesThe study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not. MethodsA population-based retrospective study was conducted in a tertiary university medical centre from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with 1 previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occurred, and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded. ResultsOf 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared with the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15; 95% CI 1.3–13.3, P = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7; 95% CI 1.8–23.8, P < 0.01). There was no neonatal or maternal death in any group. ConclusionsDespite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favourable when rupture occurs outside the trial of labour and if the uterus is unscarred.

Up-front dissection of the uterovesical space or “bladder-first approach” reduces hemorrhage and bladder injury during hysterectomy for placenta accreta spectrum: reconfirmed in 78 more cases in a prospective single-center study

BackgroundCaesarean hysterectomy (CH) for placenta accreta spectrum (PAS)may be associated with severe haemorrhage due to placental invasion of the myometrium and the uterovesical space or the parametrium. It leads to serious complications like massive haemorrhage requiring massive transfusion, coagulopathy, bladder & ureteric injuries, need for ICU admission and prolonged hospital stay.In order to reduce the complication of CH for PAS, on-goingefforts are being done to develop different surgical approaches.We have observed earlier in 12 cases that upfront dissection of uterovesical space (bladder-first approach) prior to delivery of the baby reduced haemorrhage arising from extensive neovasularization in this area, as well as bladder injury. ObjectiveObjective of this study was to assess the efficacy of Bladder- first approach in large sample in order to reduce the complication of CH for PAS disorder. MethodsWe present data of 78 more women (2017-2022) who underwent CH for PAS using the “bladder-first approach” from a tertiary care institute in Chandigarh, India.In this surgical approach, dissection of the Uterovesical fold from the lower uterine segment is done as much as possible or upto the cervix prior to making the uterine incision for delivery. During this dissection, vascular areas were isolated and coagulated with bipolar electrosurgery or ligated with silk suture and then divided ResultThe 78 women with PAS underwent CH under general anaesthesia. The mean gestational age was 35±2.5 weeks (range 25.4-38), mean blood loss was 1.56±1.06 L (range 0.4 -5 L) and mean number of blood transfusions was 2.08±2.1 units (range 0-9).Bladder injury occurred in 3/78(3.8%) and ICU admission (for ≤ 24 h) was needed by3/78(3.8%). Histology was available in 73/78 (percreta=19, increta=23 and accreta=31). There were 3/78 antenatal stillbirths. Seventy-five women had live born neonates including 2 pairs of twins. The APGAR score at 5 min ≤7 was seen in 6/77 neonates and 20/77 needed NICU care. There was one neonatal death on day 3 of life due to extreme prematurity and sepsis. Seventy-four women went home with babies including two pairs of twins. ConclusionThis data supportsUp-front dissection of the uterovesical spaceor“bladder-first approach” reduces haemorrhage and bladder injury during CH in PAS disorder, with no adverse effect on neonatal outcome. Achieving peripheral vascular control of the neovascularised uterovesical area prior to achieving control of central vascular supply (uterine arteries) reduced intra-operative haemorrhage. This approach needs no additional resources and can be practiced easily in developing countries.

ANÁLISE EPIDEMIOLÓGICA DO TRAUMA GENITOURINÁRIO NO ESTADO DO ACRE: PREENCHENDO LACUNAS DE CONHECIMENTO NA REGIÃO NORTE DO BRASIL, 2013-2023

Genitourinary traumas include injuries to the kidneys, ureters, bladder, urethra, and genital organs, often resulting in severe complications and requiring complex medical interventions. This study aims to characterize the epidemiological profile of patients with genitourinary trauma treated at a referral center in Acre, Brazil, from 2013 to 2023, highlighting demographic characteristics, types of injuries, treatments applied, and clinical outcomes. The research adopted a cross-sectional, descriptive, and retrospective approach, using secondary data from the SUS information system. A total of 102 cases were analyzed, with a predominance of male patients (85.3%) and an average age of 31.64 years. Renal traumas were the most common (59.8%), followed by urethral (20.6%) and bladder injuries (8.8%). Most patients required surgical interventions (83.3%), and the mortality rate was low (2.9%). This study fills a knowledge gap regarding the epidemiology of genitourinary traumas in Acre, providing essential data for the formulation of public health policies and prevention strategies.

Transobturator hybrid tape versus synthetic tape in treatment of female stress urinary incontinence: A prospective randomized clinical study.

To compare the clinical and operative outcomes of transobturator hybrid tape versus synthetic tapes during mid-urethral sling in treating female stress urinary incontinence (SUI). This prospective randomized study included 63 women with SUI. Patients were categorized into two groups: Group I included 32 patients who underwent midurethral sling procedure using hybrid tape; and Group II included 31 patients that had synthetic sling, using transobturator tape approach (TOT) in both groups. Two patients in group I lost to follow up and one patient in group II lost to follow up. The primary endpoint was the safety of sling erosion and major complications. The 2ry endpoint was the efficacy that was assessed objectively by the Cough stress test and subjectively by International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) and this was assessed at 1, 6, and 12 months. The following variables were compared: operative time, post-operative pain scores, duration of indwelling urethral catheter, hospital stay, and quality of life (QoL) assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) assessing the continence status before and after discharge from hospital. Patients among the two groups were normally distributed with no statistical significant difference in patient's demographic data and comorbidities. The hybrid tape procedure had a longer mean (SD) operative time of 45.3 ± 3.6 min, which was longer than that of synthetic tape procedure, at a mean (SD) of 29.5 ± (3.5) min. This increase was statistically significant (p < 0.001). The mean time to return to normal activity was significantly shorter in Group II patients compared to those in Group I. Overall cure rate (defined as no more episodes of SUI or pad use) was statistically insignificant in both groups being 86.7% and 83.3% respectively. No bladder, vascular, nervous or intestinal injuries were encountered in either group. Pain was significantly higher in hybrid tape (Group I). Post operative urgency, and urge incontinence rates were not significantly different between in both groups. Two cases in group 1 and one case in the other group, and these cases were managed by medical treatment. Vaginal sling erosion was encountered in one case in group II which was managed by sling removal. Hybrid tape may be considered as a treatment option during TOT for female SUI with comparable efficacy and safety to synthetic tape. Long term follow up should be considered.