IntroductionIatrogenic bladder injury is a rare complication following obstetric and gynecologic surgery and only sparse information is available regarding length of transurethral catheterization following injuries, suturing techniques including choice of suture, and complications. The primary aim of this systematic review was to evaluate length of transurethral catheterization in relation to complications following iatrogenic bladder injury. Second, we aimed to evaluate the number of complications following repair of iatrogenic bladder injuries and to describe suture technique and best choice of suture.Material and methodsA systematic review and meta‐analysis was conducted, and the results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. PubMed, Embase, and Medline electronic databases were searched, and followed by screening from two independent reviewers. Studies published between January 2000 and March 2023 describing methods of bladder injury repair following obstetric or gynecologic benign surgery were included. Data extraction was done using Covidence. We performed a meta‐analysis on complications after repair and explored this with a meta‐regression analysis (Metafor package R) on length of catheterization to determine if length of catheterization influenced the risk of complication. A risk of bias tool from Cochrane was used to assess risk of bias and the study was registered in PROSPERO (CRD42021290586).ResultsOut of 2175 articles, we included 21 retrospective studies, four prospective studies, and one case‐control study. In total, 595 bladder injuries were included. Cesarean section was the most prominent surgery type, followed by laparoscopically assisted vaginal hysterectomy. We found no statistically significant association between length of transurethral catheterization and numbers of complications following repair of iatrogenic bladder injuries. More than 90% of injuries were recognized intraoperatively. Approximately 1% had complications following iatrogenic bladder injury repair (0.010, 95% confidence interval 0.0015–0.0189, 26 studies, 595 participants, I2 = 4%).ConclusionsOur review did not identify conclusive evidence on the length of postoperative catheterization following bladder injury warranting further research. However, the rate of complications was low following iatrogenic bladder injury with a wide range of repair approaches.

Introduction:Iatrogenic urinary tract injuries are potential complications of gynecologic and obstetric surgery. Our aim was to evaluate on suture type and size, length of urethral catheterization, length of hospitalization, reoperation rate, follow-up, and impact on quality of life following iatrogenic bladder and ureteral injury. Materials and methods:In total, 81 women met inclusion criteria. Bladder injuries included 55 women, ureteral injuries 23 women, and three women had bladder and ureteral injury. Results:The women were divided into three subgroups based on operation indication: Benign (N=37), cesarean section (N=11), and malignant (N=33). Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4 days (95%CI: 9.1 -13.6). The most frequent suture type was 3.0 Vicryl in all subgroups. Most ureteral injuries were managed by neoimplantation followed by ureteral stenting for 38.0 days (95%CI: 22.0 -54.0) and transurethral catheterization for 16.9 days (95%CI: 5.3 -28.4), or by ureteral stenting for 46.7 days (95%CI: 31.5 -61.2) and transurethral catheterization for 6.25 days (95%CI: 1.0 -13.5).Multiple linear regression showed a statistic significant increased median length of urethral catheterization when duration of surgery increased. A statistically significant longer median length of catheterization on 156% was found in the cesarean group compared to the benign group. Conclusion:Our study demonstrates a high reoperation rate, and a high fistula rate in case of malignancy. Length of catheterization was high even in case of benign surgery, however, only two women developed a fistula in the benign group, suggesting reduction of catheterization length.