Bladder injury associated with rupture of the uterus

Rupture of the uterus is still a very common obstetric emergency in developing countries, and the urinary bladder is often injured in these patients. This fact is not fully documented in the literature. One hundred consecutive cases of rupture of the uterus in patients admitted during a 10-year period to the King George Hospital, Visakhapatnam, India, were analyzed. Bladder injury occurred in 22%. Thus, uterine rupture constitutes one of the important causes of bladder injury. In uterine rupture cases the most common clinical signs of concomitant bladder damage are hematuria and meconium-stained urine. Instillation of methylene blue solution into the bladder during surgery can help to identify small bladder rents. Routine postoperative drainage of the bladder by indwelling catheter in all cases of ruptured uterus with suspected bladder injury is an important aid to healing of the contused, devitalized bladder and can avert vesicovaginal fistula formation.