Transvesical cesarean following bowel and urinary tract reconstructive surgery

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Reproductive Medicine

Background:

• A patient presented with a history of imperforate anus, ectopic intravaginal urethra, and vaginal/urethral strictures.
• Previous reconstructive surgeries resulted in significant anatomical challenges, including the bladder covering the anterior uterine surface and extensive bowel adhesions obscuring the uterus.
• Pelvic bone and soft-tissue deformity necessitated cesarean delivery.

Observation:

• An intentional transvesical cesarean approach was utilized for delivery.
• Anterior and posterior vertical cystotomies were performed to access the anterior uterine wall.
• The fetus was delivered via a vertical uterine incision.

Findings:

• The transvesical cesarean delivery was successfully completed.
• The patient experienced a full recovery with no genitourinary complaints at 6 months postpartum.
• This case demonstrates the feasibility of a transvesical approach in complex obstetric scenarios.

Implications:

• This surgical technique offers a viable alternative for cesarean delivery in patients with severe pelvic and genitourinary abnormalities.
• Highlights the importance of tailored surgical strategies for complex obstetric cases.
• Suggests potential for improved maternal and fetal outcomes in challenging anatomical situations.