Obstetric-associated lower urinary tract injuries: a single-center study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20222469Keywords:
Bladder, Cesarean, Injury, Repair, SepsisAbstract
Background: Urinary tract injury is a known complication of obstetric and gynecologic surgery. Intraoperative identification of injury permits prompt repair and potentially lessens postoperative sequelae including patient morbidity and cost. Delayed diagnosis of urinary tract injuries can result in physical complications beyond the site of the injury, such as genitourinary fistula formation, renal injury, sepsis, death, and psychosocial dysfunction.
Methods: We describe the management of 27 patients with such injuries, including their demographic profile, associated factors, and complications at a tertiary institution in a retrospective study from February 2013 to March 2021.
Results: Bladder injuries were the most common (81.5%), mostly occurring during emergency cesarean delivery, with previous cesarean delivery and adhesions being risk factors. A primary repair was attempted at the referring institution in 18.5% of cases. Repair at the tertiary institution was mostly performed by consultants (66.7%).
Conclusions: Early recognition and primary repair are associated with fewer complications.
References
Rashid TG, Revicky V, Terry TR. Caesarean bladder and ureteric injuries in the UK. J Clin Urol. 2014;7(5):318-22.
Tarney CM. Bladder injury during caesarean delivery. Curr Wom Health Rev. 2013;9(2):70-6.
Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL. Risk factors for bladder injury during cesarean delivery. Obstet Gynecol. 2005;105(1):156-60.
Rahman MS, Gasem T, Al Suleiman SA, Al Jama FE, Burshaid S, Rahman J. Bladder injuries during cesarean section in a University Hospital: a 25-year review. Arch Gynecol Obstet. 2009;279(3):349-52.
Oliphant SS, Bochenska K, Tolge ME, Catov JM, Zyczynski HM. Maternal lower urinary tract injury at the time of Cesarean delivery. Int Urogynecol J. 2014;25(12):1709-14.
Moodliar M, Moodley J. Complications following caesarean delivery at king Edward VIII hospital, Durban, South Africa. Obstet Gynaecol Forum. 2004;14(3):21-6.
Rao D, Yu H, Zhu H, Duan P. The diagnosis and treatment of iatrogenic ureteral and bladder injury caused by traditional gynaecology and obstetrics operation. Arch Gynecol Obstet. 2012;285(3):763-5.
Yossepowitch O, Baniel J, Livne PM. Urological injuries during cesarean section: intraoperative diagnosis and management. J Urol. 2004;172(1):196-9.
Gungorduk K, Asicioglu O, Celikkol O, Sudolmus S, Ark C. Iatrogenic bladder injuries during caesarean delivery: a case control study. J Obstet Gynaecol. 2010;30(7):667-70.
Salman L, Aharony S, Shmueli A, Wiznitzer A, Chen R, Gabbay-Benziv R. Urinary bladder injury during cesarean delivery: maternal outcome from a contemporary large case series. Eur J Obstet Gynecol Reprod Biol. 2017;213:26-30.
Naicker S, Naidoo TD, Moodley J. Obstetric-associated lower urinary tract injuries: a case series from a tertiary centre in a low-resource setting. Case Rep Wom Health. 2020;27:e00218.
Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv. 1996;51(9):568-74.
Lee JS, Choe JH, Lee HS, Seo JT. Urologic complications following obstetric and gynecologic surgery. Korean J Urol. 2012;53(11):795-9.
Ramphal S, Moodley J. Vesicovaginal fistula: obstetric causes. Curr Opin Obstet Gynecol. 2006;18(2):147-51.
Armenakas NA, Pareek G, Fracchia JA. Iatrogenic bladder perforations: longterm followup of 65 patients. J Am Coll Surg. 2004;198(1):78-82.