Iatrogenic bladder injuries

Iatrogenic injuries and bladder injuries can be closed and open.

Causes of Bladder Damage

• bladder catheterization;
• bougienage of the urethra;
• surgery on the pelvic organs;
• obstetric and gynecological surgery;
• performing a TVT (free synthetic loop) operation;
• TOUR of the bladder and prostate;
• hernia repair;
• orthopedic treatment of pelvic fractures;
• aorto-femoral shunting;
• installation of intrauterine device.

[1], [2], [3]

Risk factors for iatrogenic damage and bladder injury

Conditions predisposing to intraoperative bladder damage.

• Poor exposure or visibility of the operative field (large formations in the pelvis; pregnancy; obesity : pelvic hemorrhage; malignant neoplasm; insufficient incision or retraction, poor lighting).
• Anatomical deformities (cicatricial adhesions, previously performed operations on the pelvic organs; prolapse of the pelvic organs: congenital anomalies; radiation therapy; chronic inflammation of the pelvic organs; endometriosis, malignant infiltration: stretched or thin bladder wall).

[4], [5], [6]

Diagnosis of iatrogenic damage and bladder injuries

Symptoms of intraoperative bladder damage:

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

If you suspect damage to the bladder during the operation, perform a revision of its walls, inject indigocarmine along the catheter. Diluted in 200-300 ml of sterile isotonic solution of sodium chloride, in order to identify possible leakage of urine. In doubtful situations, perform cystotomy for revision of the bladder, allowing to determine the location, extent of damage and its relation to the mouths of the ureters.

Symptoms of bladder damage in the early postoperative period:

• gematuria ;
• oliguria;
• elevated serum creatinine level.
• lower abdominal pain.

In a later period, symptoms of peritoneal irritation, the appearance of urinary leakages and fistulas may occur.

If you suspect iatrogenic damage to the bladder in the postoperative period, the patient is shown retrograde cystography.

[7], [8]

Treatment of iatrogenic injuries and bladder injuries

Treatment of iatrogenic damage to the bladder, as a rule, prompt.

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

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

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

If the damage is detected late or complications have arisen, the treatment is selected individually, taking into account the patient’s condition and the time elapsed since the injury. In some cases, multi-stage treatment with the temporary use of suprambiastinal urine is necessary.

[9]