Bladder injuries at caesarean section: risk factors and management

Olanrewaju  Sorinola

doi:10.51496/jogm.v5.319

Authors

Olanrewaju Sorinola Consultant Urogynaecologist, University of Warwick Medical School, Gibbet Hill, Coventry; and South Warwickshire University NHS Foundation Trust, Warwick

DOI:

https://doi.org/10.51496/jogm.v5.319

Keywords:

Bladder, Lower urinary tract, Caesarean section, Injury

Abstract

Iatrogenic injury to the urinary bladder may occur during caesarean section (CS) due to the close anatomic proximity of the two organs. Risk factors predisposing to bladder injuries during caesarean deliveries include dense adhesions, CS in advanced/prolonged labour, failed instrumental deliveries, uterine rupture, and attempts to control bleeding following repeat CS. An awareness of the risk factors and mechanisms of injury should help the obstetrician prevent bladder injuries. Early recognition of injury and intraoperative repair during the primary surgery most often result in less morbidity for the patient and a more successful outcome.

Metrics

Metrics Loading ...

References

Geoffrey Chamberlain. Caesarean section. In: Chamberlain G, Steer PJ, eds. Turnbull’s obstetrics. 3rd ed. London: Churchill Livingstone; 2002, pp. 601–17.

Hehir MP, Ananth CV, Siddiq Z, Flood K, Friedman AM, D’Alton ME. Cesarean delivery in the United States 2005 through 2014: a population-based analysis using the Robson 10-Group classification system. Am J Obstet Gynecol 2018; 219(1): 105. e1–e11. doi: 10.1016/j.ajog.2018.04.012 DOI: https://doi.org/10.1016/j.ajog.2018.04.012

Stemming the global caesarean section epidemic. Lancet. 2018; 392(10155): 1279. doi: 10.1016/S0140-6736(18)32394-8 DOI: https://doi.org/10.1016/S0140-6736(18)32394-8

Sandall J, Tribe RM, Avery L, Mola A, Visser GHA, Homer CSE, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018; 392(10155): 1349–57. doi: 10.1016/S0140-6736(18)31930-5 DOI: https://doi.org/10.1016/S0140-6736(18)31930-5

Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018; 392(10155): 1341–8. doi: 10.1016/S0140-6736(18)31928-7 DOI: https://doi.org/10.1016/S0140-6736(18)31928-7

Vaidya B, Chaudhari M, Parmar D, Chaudhari V, Daginawala T, Shah R. Bladder injuries during obstetrical and gynecological surgeries. Int Surg J 2017; 4: 2177–80. doi: 10.18203/2349-2902.isj20172578 DOI: https://doi.org/10.18203/2349-2902.isj20172578

Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL. Risk factors for bladder injury during caesarean section. Am J Obst Gynecol 2005; 105(1): 156–60. doi: 10.1097/01.AOG.0000149150.93552.78 DOI: https://doi.org/10.1097/01.AOG.0000149150.93552.78

Eisenkop SM, Richman R, Platt LD, Paul RH. Urinary tract injury during caesarean section. Obstet Gynaecol 1982; 60: 591–6.

Onura VC, al Ariyan R, Koko AH, Abdelwahab AS, al Jawini N. Major injuries to the urinary tract in association with childbirth. East Afr Med J 1997; 74(8): 523–6.

Buchholz NP, Daly-Grandeau E, Huber-Buchholz MM. Urological complications associated with caesarean section. Eur J Obstet Gynecol Reprod Biol 1994; 56: 161–3. doi: 10.1016/0028-2243(94)90163-5 DOI: https://doi.org/10.1016/0028-2243(94)90163-5

Rajasekar D, Hall M. Urinary tract injuries during obstetric intervention. BJOG 1997; 104(6): 731–4. doi: 10.1111/j.1471-0528.1997.tb11986.x DOI: https://doi.org/10.1111/j.1471-0528.1997.tb11986.x

Safrai M, Stern S, Gofrit O, Hidas G, Kabiri D. Urinary tract injuries during cesarean delivery: long-term outcome and management. J Matern Fetal Neonat Med 2022; 35(18): 3547–54. doi: 10.1080/14767058.2020.1828336 DOI: https://doi.org/10.1080/14767058.2020.1828336

Wei G, Harley F, O’Callaghan M, Adshead J, Hennessey D, Kinnear N. Systematic review of urological injury during caesarean section and hysterectomy. Int Urogynecol J 2023; 34: 371–89. doi: 10.1007/s00192-022-05339-7 DOI: https://doi.org/10.1007/s00192-022-05339-7

Manidip P, Soma B. Cesarean bladder injury – obstetrician’s nightmare. J Fam Med Prim Care 2020; 9: 4526–9. doi: 10.4103/jfmpc.jfmpc_586_20 DOI: https://doi.org/10.4103/jfmpc.jfmpc_586_20

Baskett TF, Calder AA, Arulkumaran S. Obstetrics hysterectomy. In: Arukumaran S, Robson MS, eds. Munro Kerr’s operative obstetrics. 11th ed. Edinburgh: Saunders Elsevier; 2007, pp. 309–14.

Adıgüzel FI, Adıgüzel C, Uysal G, Karatasi M. The analyses of length and type of bladder injury during cesarean section in patients with or without placenta accreta: a retrospective case-control study. BMC Pregnancy Childbirth 2025; 25: 466. doi: 10.1186/s12884-025-07604-1 DOI: https://doi.org/10.1186/s12884-025-07604-1

Narava S, Pokhriyal SC, Singh SB, Barpanda S, Bricker L. Outcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247: 143–8. doi: 10.1016/j.ejogrb.2020.01.035 DOI: https://doi.org/10.1016/j.ejogrb.2020.01.035

Abdelazim I, Alanwar A, Shikanova S, Kanshaiym S, Farghali M, Mohamed M, et al. Complications associated with higher order compared to lower order cesarean sections. J Matern Fetal Neonatal Med 2020; 33: 2395–402. doi: 10.1080/14767058.2018.1551352 DOI: https://doi.org/10.1080/14767058.2018.1551352

Tarney CM. Bladder injury during cesarean delivery. Curr Womens Health Rev 2013; 9: 70–6. doi: 10.2174/157340480902140102151729 DOI: https://doi.org/10.2174/157340480902140102151729

Franzini M. Delivery through the bladder during cesarean section. J Urol 1981; 125(6): 422–3. doi: 10.1016/S0022-5347(17)55059-4 DOI: https://doi.org/10.1016/S0022-5347(17)55059-4

Sorinola O, Murthy VN, Nallaswamy V, Srivastava S. Urinary tract injuries at caesarean section: prevention and management. Br J Hosp Med 2006; 67(9): 456–9. doi: 10.12968/hmed.2006.67.9.21996 DOI: https://doi.org/10.12968/hmed.2006.67.Sup9.21996

Reddy D, Laher AE, Moeng M, Adam A. Bladder trauma: a guideline of the guidelines. BJU Int 2024; 133(4): 365–74. doi: 10.1111/bju.16236 DOI: https://doi.org/10.1111/bju.16236

Porcaro A, Zicari M, Antiolli S, Pianon R, Monaco C, Migliorini F, et al. Vesicouterine fistulas following caesarean section. Int Urol and Nephrol 2002; 34: 335–44. doi: 10.1023/A:1024443822378 DOI: https://doi.org/10.1023/A:1024443822378