Surgical Management of Unintentional Transvesical Caesarean Section: A study at a Tertiary Care Teaching Hospital (RIMS), Adilabad
Creators
- 1. Associate Professor, Department of General Surgery, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad, Telangana State
Description
Background: Iatrogenic bladder injury is a very rare occurrence in obstetric and gynecologic surgeries. There is limited data available pertaining to the optimal duration for transurethral catheterization post-injury, suture methodologies involving suture selection, and the potential complications involved. The objective is to evaluate the frequency, factors contributing to risk, treatment approaches, as well as the immediate and extended consequences of inadvertent transvesical cesarean section (UTV-CS). Methods: This case-control study was carried out in the Departments of General Surgery and Obstetrics and Gynecology, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad. The prevalence was determined based on the total number of CS procedures conducted at the center during the study’s timeframe from Jan 2019 to May 2023. The diagnoses of UTV-CS were verified through a manual examination of all charts and surgical procedure descriptions. Instances of bladder wall injury without UTV-CS were not considered. Results: A total of 26,236 deliveries took place between Jan 2019 to May 2023, with 11,785 cesarean sections (CSs) performed, accounting for 44.92% of the total deliveries. Instances of bladder injury without a ureterovesical-transection cesarean section (UTV-CS) were excluded from the analysis. Four CSs presented complications in the form of extensive bladder injuries, leading to unintentional fetal extraction through the bladder. The overall incidence of UTV-CS was found to be 0.0339%, which translates to 1 in every 2,947 CS procedures. Conclusion: The incidence of bladder injury during cesarean sections is low, it should always be considered as a potential complication. This study represents the first attempt to evaluate the incidence of UTV-CS, which might indicate a reluctance among obstetricians to report severe bladder injuries associated with cesarean sections. The risk factors identified for UTV-CS appear to be in line with factors generally associated with bladder injuries. However, due to the limited number of UTV-CS cases, a comprehensive evaluation of related risk factors in comparison to milder bladder injuries could not be carried out, and the conclusions are constrained by the scarcity of cases.
Abstract (English)
Background: Iatrogenic bladder injury is a very rare occurrence in obstetric and gynecologic surgeries. There is limited data available pertaining to the optimal duration for transurethral catheterization post-injury, suture methodologies involving suture selection, and the potential complications involved. The objective is to evaluate the frequency, factors contributing to risk, treatment approaches, as well as the immediate and extended consequences of inadvertent transvesical cesarean section (UTV-CS). Methods: This case-control study was carried out in the Departments of General Surgery and Obstetrics and Gynecology, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad. The prevalence was determined based on the total number of CS procedures conducted at the center during the study’s timeframe from Jan 2019 to May 2023. The diagnoses of UTV-CS were verified through a manual examination of all charts and surgical procedure descriptions. Instances of bladder wall injury without UTV-CS were not considered. Results: A total of 26,236 deliveries took place between Jan 2019 to May 2023, with 11,785 cesarean sections (CSs) performed, accounting for 44.92% of the total deliveries. Instances of bladder injury without a ureterovesical-transection cesarean section (UTV-CS) were excluded from the analysis. Four CSs presented complications in the form of extensive bladder injuries, leading to unintentional fetal extraction through the bladder. The overall incidence of UTV-CS was found to be 0.0339%, which translates to 1 in every 2,947 CS procedures. Conclusion: The incidence of bladder injury during cesarean sections is low, it should always be considered as a potential complication. This study represents the first attempt to evaluate the incidence of UTV-CS, which might indicate a reluctance among obstetricians to report severe bladder injuries associated with cesarean sections. The risk factors identified for UTV-CS appear to be in line with factors generally associated with bladder injuries. However, due to the limited number of UTV-CS cases, a comprehensive evaluation of related risk factors in comparison to milder bladder injuries could not be carried out, and the conclusions are constrained by the scarcity of cases.
Files
IJPCR,Vol15,Issue9,Article165.pdf
Files
(1.6 MB)
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Additional details
Dates
- Accepted
-
2023-09-22
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue9,Article165.pdf
- Development Status
- Active
References
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