Advertisement

Unintentional transvesical caesarean section: incidence, risk factors, surgical technique and post-operative management

      Abstract

      Objective(s)

      To assess incidence, risk factors, management, and short and long-term outcomes of unintentional transvesical caesarean section (UTV-CS) defined as any extraction of the fetus through a double full thickness bladder wall cystotomy.

      Study design

      Data about all UTV-CS between January 2013 and December 2017 were retrieved searching the diagnosis of bladder injury and bladder repair during caesarean section (CS) in our comprehensive computerized labor and delivery database and register. CS with bladder wall injury not classified as UTV-CS were excluded. Data analysis included maternal history, demographics and obstetric parameters, details regarding CSs, bladder injury location and extension, and short- and long-term maternal outcomes.

      Results

      Among 28,822 deliveries, 7,616 (26.42%) were CSs. Three cases of UTV-CS were identified with comprehensive incidence of 0.039%. We provided details of the reported cases and described bladder repair procedure.

      Conclusion(s)

      This is the first study that assessed the incidence of UTV-CS. UTV-CS risk factors are consistent with factors related to milder bladder injuries. The risk of bladder injury during CS should be always considered, despite the low incidence of this complication. Prompt diagnosis and surgical repair seem to allow avoiding severe complications and recovery of a normal urological function even in UTV-CS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Cordon B.H.
        • Fracchia J.A.
        • Armenakas N.A.
        Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution.
        Urology. 2014; 84: 222-226
        • Dobrowolski Z.F.
        • Lipczyn˜ski W.
        • Drewniak T.
        • Jakubik P.
        • Kusionowicz J.
        External and iatrogenic trauma of the urinary bladder: a survey in Poland: URINARY BLADDER INJURY IN POLAND.
        BJU Int. 2002; 89: 755-756
        • Phipps M.G.
        • Watabe B.
        • Clemons J.L.
        • Weitzen S.
        • Myers D.L.
        Risk factors for bladder injury during cesarean delivery.
        Obstet Gynecol. 2005; 105: 156-160
        • Gungorduk K.
        • Asicioglu O.
        • Celikkol O.
        • Sudolmus S.
        • Ark C.
        Iatrogenic bladder injuries during caesarean delivery: a case control study.
        J Obstet Gynaecol. 2010; 30: 667-670
        • Rahman M.S.
        • Gasem T.
        • Al Suleiman S.A.
        • Al Jama F.E.
        • Burshaid S.
        • Rahman J.
        Bladder injuries during cesarean section in a University Hospital: a 25-year review.
        Arch Gynecol Obstet. 2009; 279: 349-352
        • Oliphant S.S.
        • Bochenska K.
        • Tolge M.E.
        • Catov J.M.
        • Zyczynski H.M.
        Maternal lower urinary tract injury at the time of Cesarean delivery.
        Int Urogynecol J Pelvic Floor Dysfunct. 2014; 25: 1709-1714
        • Salman L.
        • Aharony S.
        • Shmueli A.
        • Wiznitzer A.
        • Chen R.
        • Gabbay-Benziv R.
        Urinary bladder injury during cesarean delivery: maternal outcome from a contemporary large case series.
        Eur J Obstet Gynecol Reprod Biol. 2017; 213: 26-30
        • Resnik E.
        • Laifer S.A.
        • O’Donnell W.F.
        Transvesical cesarean following bowel and urinary tract reconstructive surgery.
        Obstet Gynecol. 1992; 79: 884-886
        • Juneja S.
        • Tandon P.
        • Kochhar B.
        • Singh H.
        • Sharma B.
        A rare case of transvesical cesarean section.
        Int J Appl Basic Med Res. 2017; 7: 205-206
        • Moore E.E.
        • Cogbill T.H.
        • Jurkovich G.J.
        • et al.
        Organ injury scaling. III: chest wall, abdominal vascular, ureter, bladder, and urethra.
        J Trauma. 1992; 33: 337-339
        • Benchimol E.I.
        • Smeeth L.
        • Guttmann A.
        • et al.
        The REporting of studies conducted using Observational Routinely-collected health Data (RECORD) statement.
        PLoS Med. 2015; 12e1001885
        • Sharp H.T.
        • Adelman M.R.
        Prevention, recognition, and management of urologic injuries during gynecologic surgery.
        Obstet Gynecol. 2016; 127: 1085-1096
        • Laganà A.S.
        • Cromi A.
        • Tozzi R.
        • Franchi M.
        • Lukanović D.
        • Ghezzi F.
        Uterine scar healing after cesarean section: managing an old surgery in an evidence-based environment.
        J Invest Surg. 2018; https://doi.org/10.1080/08941939.2018.1465145:1–3
        • Lee J.S.
        • Choe J.H.
        • Lee H.S.
        • Seo J.T.
        Urologic complications following obstetric and gynecologic surgery.
        Korean J Urol. 2012; 53: 795-799
        • Mariona F.G.
        • Evans T.N.
        Pregnancy following repair of anal and vaginal atresia and bladder exstrophy.
        Obstet Gynecol. 1982; 59: 653-655
        • Vordermark J.S.
        • Deshon G.E.
        • Agee R.E.
        Management of pregnancy after major urinary reconstruction.
        Obstet Gynecol. 1990; 75: 564-567
        • Kapoor D.
        • Chipde S.S.
        • Agrawal S.
        • Chipde S.
        • Kapoor R.
        Delivery after augmentation cystoplasty: implications and precautions.
        J Nat Sci Biol Med. 2014; 5: 206-209
        • Everett H.S.
        • Mattingly R.F.
        Urinary tract injuries resulting from pelvic surgery.
        Am J Obstet Gynecol. 1956; 71: 502-514
        • Tarney C.M.
        Bladder injury during cesarean delivery.
        Curr Womens Health Rev. 2013; 9: 70-76
        • ractice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons
        • P
        Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion.
        Fertil Steril. 2013; 99: 1550-1555
        • Inaba K.
        • Okoye O.T.
        • Browder T.
        • et al.
        Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury.
        J Trauma Acute Care Surg. 2013; 75: 1019-1023
        • Wolf J.S.
        • Bennett C.J.
        • Dmochowski R.R.
        • Hollenbeck B.K.
        • Pearle M.S.
        • Schaeffer A.J.
        Best practice policy statement on urologic surgery antimicrobial prophylaxis.
        J Urol. 2008; 179: 1379-1390