Omission of a Bladder Flap during Cesarean Birth in Primiparous Women

Creation of a bladder flap has traditionally been an integral surgical step of Cesarean birth, and the practicality of such a procedure to create a bladder flap is still highly debated.

A total of 208 patients undergoing a primary cesarean birth were randomized. Group 1 (bladder flap) had 101 patients and group 2 (omission of a bladder flap) had 100 patients. The primary outcome was the total operating time and secondary outcomes were postoperative urinary symptoms, bladder injury, postoperative urinary retention, and postoperative residual urine volume.

No significant differences were found among groups in terms of mean total operating time and mean skin incision-to-delivery time. No bladder injury occurred in either group. Postoperative urine retention observed in the bladder flap group was 2%. The postoperative residual urine volume was significantly more in the bladder flap group compared to the non-bladder flap group (24.5 ± 2.8 vs. 16.2 ± 1.4 mL). The number of patients with dysuria was significantly higher in the bladder flap group (42 vs. 13%).

The creation of a bladder flap during cesarean birth does not have an effect on intraoperative results and operation time, but it is associated with short-term urinary complaints, such as postoperative urinary retention and dysuria.