Iatrogenic bladder injury following gynecologic and obstetric surgery: A systematic review and meta‐analysis

Abstract

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.

Occult bladder lesion following caesarean section - a case report

“…According to the NICE guideline [7] the incidence is approximately 0.009 per cent in elective primary caesarean sections. The risk increases to 0.1 per cent for one previous caesarean section and to 0.3 per cent for two previous caesarean sections [2,4,5], as in the present case. Previous pelvic and abdominal surgery, adhesions, low gestational age, and low birth weight all increase the risk, whereas the risk when comparing emergency and elective caesarean sections is uncertain [2,3,4,6].…”

“…The risk increases to 0.1 per cent for one previous caesarean section and to 0.3 per cent for two previous caesarean sections [2,4,5], as in the present case. Previous pelvic and abdominal surgery, adhesions, low gestational age, and low birth weight all increase the risk, whereas the risk when comparing emergency and elective caesarean sections is uncertain [2,3,4,6]. The majority (91 per cent) of bladder lesions are diagnosed intraoperatively and most urinary tract lesions within 10-14 days postoperatively [3,4,5].…”

“…Eighty-nine per cent of the lesions affect the bladder and the rest involves the ureters [2]. In a recent review of iatrogenic bladder injuries following benign obstetrical and gynaecological surgeries caesarean sections accounted for the highest number of bladder injuries (up to 40 per cent of identified injuries) followed by hysterectomies [4]. According to the NICE guideline [7] the incidence is approximately 0.009 per cent in elective primary caesarean sections.…”

“…Previous pelvic and abdominal surgery, adhesions, low gestational age, and low birth weight all increase the risk, whereas the risk when comparing emergency and elective caesarean sections is uncertain [2,3,4,6]. The majority (91 per cent) of bladder lesions are diagnosed intraoperatively and most urinary tract lesions within 10-14 days postoperatively [3,4,5]. Lesions can be identified by cystoscopy or filling the bladder with water or methylene blue [6].…”

Iatrogenic Bladder Injury During Laparoscopic Hysterectomy: A Case Report and Discussion of Anatomic Variations

“…Kostov et al [7] explored in depth other anatomical variations and factors to consider during gynecologic surgery in patients with these variants. Other factors that may make navigating a patient's anatomy difficult are obesity and adhesions due to difficulty obtaining a clear visual field [12]. These factors likely played a role in the iatrogenic bladder injury found in the presented patient case, given the patient's BMI of 41.2 kg/m 2 and extensive surgical history increasing the likelihood of adhesions.…”