Iatrogenic injuries and trauma to the bladder

Iatrogenic injuries and trauma to the bladder can be closed and open.

Causes of Bladder Damage

• bladder catheterization;
• urethral bougienage;
• surgical interventions on the pelvic organs;
• obstetric and gynecological operations;
• performing TVT (free synthetic loop) operation;
• TUR of the bladder and prostate;
• hernia repair;
• orthopedic treatment of pelvic bone fractures;
• aortofemoral bypass;
• installation of an intrauterine device.

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Risk factors for iatrogenic bladder injury and trauma

Conditions predisposing to intraoperative bladder injury.

• Poor exposure or visibility of the surgical field (large pelvic masses; pregnancy; obesity; pelvic bleeding; malignancy; insufficient incision or retraction, poor lighting).
• Anatomical deformities (scar adhesions, previous pelvic surgeries; prolapse of pelvic organs: congenital anomalies; radiation therapy; chronic pelvic inflammation; endometriosis, malignant infiltration: stretched or thin bladder wall).

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Diagnosis of iatrogenic injuries and trauma to the bladder

Symptoms of intraoperative bladder injury:

• the appearance of fluid (urine) in the surgical field;
• visible bladder wound;
• the appearance of air in the urine collection bag (during laparoscopic operations);
• the appearance of hematuria.

If there is a suspicion of damage to the bladder during surgery, its walls are inspected, and indigo carmine diluted in 200-300 ml of sterile isotonic sodium chloride solution is administered through a catheter in order to detect possible urine leakage. In questionable situations, cystotomy is performed to inspect the bladder, which allows determining the location, extent of damage, and its relationship to the ureteral orifices.

Symptoms of bladder injury in the early postoperative period:

• hematuria;
• oliguria;
• elevated serum creatinine level.
• pain in the lower abdomen.

At a later stage, symptoms of peritoneal irritation, urinary leaks and fistulas may appear.

If iatrogenic bladder injury is suspected in the postoperative period, the patient is shown retrograde cystography.

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Treatment of iatrogenic injuries and trauma to the bladder

Treatment of iatrogenic bladder injuries is usually surgical.

The principles of treatment of iatrogenic bladder injuries are the same as for non-iatrogenic ones.

Indications for laparoscopic correction for injuries that occurred directly during laparoscopic surgery:

• minor damage;
• the urologist is proficient in the technique of laparoscopic operations on the bladder;
• good exposure and visibility of the surgical field;
• there is no risk of damage to the ureters or bladder neck.

If the injury is detected late or complications arise, treatment is selected individually, taking into account the patient's condition and the time that has passed since the injury. In some cases, multi-stage treatment with temporary use of supravesical urinary diversion is necessary.

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