Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution

To analyze the etiology, diagnosis, and long-term outcomes of iatrogenic nonendoscopic bladder injuries over a 24-year period.

All iatrogenic bladder injuries were entered prospectively into our database from 1990 to 2014. Information gathered included causative procedure, injury characteristics, management, and outcome.

A total of 127 patients with nonendoscopic iatrogenic bladder injuries were included (111 women [87%], 16 men [13%]; mean age 51 years [range, 23-84]). Risk factors were identified in 92 patients (79%) including prior surgery, inflammation, and extensive tumor. Obstetric-gynecologic surgery accounted for most injuries (65%), with hysterectomy the most common procedure, followed by cesarean section. General surgery and nonendoscopic urologic injuries accounted for 22% and 13% respectively. Most injuries occurred during open surgery (77%) compared with vaginal (12%) and laparoscopic surgeries (11%). Laparoscopic surgery was associated with a delay in diagnosis, P=.002. Bladder injuries with concomitant ureteral injuries were more likely to have long-term complications, P=.001.

In analyzing iatrogenic bladder injuries at our institution over 24 years, we observed that hysterectomy and cesarean sections were the 2 most common causative procedures. A delay in diagnosis was more likely to occur during laparoscopic surgery. Complications occurred more commonly with a concomitant ureteral injury.