Urinary Incontinence after Iatrogenic Bladder Injury during Cesarean Section. A Ten-Year Single-Center Retrospective Analysis and Review of the Literature

Abstract

Background: Bladder injuries during caesarean delivery are rare but serious intraoperative complications. Short-term effects of bladder injuries include prolonged catheterization and urinary infections. Nevertheless, there is a lack of data regarding long-term adverse outcomes, such as lower urinary tract dysfunctions. Our aim is to retrospectively analyze the long-term prevalence of urinary incontinence after iatrogenic bladder injury occurring during caesarean delivery in a singleton first-level Obstetric Department. Moreover, with a systematic review we aimed to define on urinary symptoms, primarily urinary incontinence. Methods: All patients who underwent caesarean delivery with bladder injuries in our first-level obstetrics department between 1st January 2010 and 31st December 2020 were included and reached for a telephone interview during 2021. Moreover, a systematic literature review was conducted up to November 28, 2021. Data selection and extraction were conducted in accordance with PICOS (Population, Intervention, Comparison, Outcome and Study design) criteria for study selection, using a piloted form specifically designed for capturing information on the study and characteristics. Results: Throughout the obstetrics database of our department, we identified 16 patients with iatrogenic bladder injury in 3725 caesarean delivery, with an overall incidence of 0.43%. Ten patients out of 16 (63%) attended the interview and four of them (40%) developed urinary incontinence. Three studies met the criteria for the systematic review. The incidence of bladder injuries varied from 0.05 to 0.47%. The incidence of urinary incontinence ranged from 4.9 to 37.5%, regardless the type of incontinence with no information about any treatment need. Conclusions: The incidence of bladder injuries associated with caesarean delivery in our population was similar to levels reported in the literature. Even if out of only three papers, the incidence of urinary incontinence resulted in a wide range among authors. In conclusion, urinary incontinence seems to be related to iatrogenic bladder injury during caesarean section, but, due to the lack of additional data, more studies are needed to precisely define the causality link.