Iatrogenic bladder injuries during obstetric and gynecological procedures

OBJECTIVE: To review the frequency of iatrogenic bladder injuries (IBI) occurring during obstetric and gynecological (OBG) procedures and we report a single center experience with these emergency urological consultations and interventions and analyze their outcomes and correlate them with the present day trends.

METHODS: We reviewed retrospectively the relevant data of all IBI during various OBG procedures from the Medical Records of Abha Maternity Hospital, the OBG wing of Assir Central Hospital, Abha, Saudi Arabia over a period of 4.5 years (September 2000 to February 2005). Various relevant factors of the injuries were studied with their final outcome.

RESULTS: Out of the 8,684 OBG procedures carried out during this period there were 20 occasions of IBI directly related, with an overall incidence of 0.23%. The majority of injuries were seen during obstetric procedures (85%) and 15% during gynecological procedures. Notably 90% of them were recognized intraoperatively and managed. Concomitant ureteric injury was noticed in 20% of the cases. Endourological and surgical options were both used in the management. Overall outcomes were very satisfactory, unrelated to the site, type or other associated injuries.

CONCLUSION: The bladder is the most commonly injured organ during OBG interventions. Prompt recognition and repair of injuries should be the main goal. Gynecologists should be able to do at least a minimum diagnostic cystoscopy in emergency situations. It is well established that this can lessen, missing iatrogenic urinary tract injuries in this era of increasing gamut of gynecologic surgical and laparoscopic procedures.