Cesarean bladder injury - obstetrician's nightmare

Area of Science:

• Obstetrics and Gynecology
• Surgical Urology

Background:

• The urinary bladder is anatomically adjacent to the uterus, making it vulnerable to injury during cesarean sections (CS).
• Several factors increase the risk of bladder injury during CS, including prolonged labor, uterine scarring, intra-abdominal adhesions, emergency procedures, and cesarean hysterectomy.

Purpose of the Study:

• To highlight the risk of intraoperative urinary bladder injury during cesarean sections.
• To inform healthcare providers, particularly family physicians in community obstetrics, about predisposing factors and management strategies for bladder injuries.
• To emphasize the importance of meticulous surgical technique and awareness to prevent potential legal consequences.

Main Methods:

• Review of common predisposing factors for bladder injury during cesarean section.
• Description of typical injury location (bladder dome) and anatomical considerations.
• Outline of surgical repair techniques, including two-layer suturing with specific suture materials (3-0 & 2-0 polyglycolic acid).
• Standard post-operative management including suprapubic cystostomy and transurethral catheterization for 10-14 days.

Main Results:

• The dome of the bladder is the most common site of injury, typically located 6-10 cm from the trigonal area.
• Bladder rents are effectively repaired using a two-layer suturing technique.
• Postoperative management involves suprapubic cystostomy and transurethral catheterization for a duration of 10-14 days.

Conclusions:

• Awareness of predisposing factors and meticulous surgical exploration are essential to prevent intraoperative bladder injuries during cesarean sections.
• Proper surgical repair and post-operative management are critical for successful outcomes.
• Failure to recognize or manage bladder injuries, particularly in uncomplicated cases, can lead to legal repercussions.