King Edward Medical University/Lady Willingdon Hospital, Lahore, Pakistan.
Institute of Public Health, Lahore, Pakistan.
Sci Rep. 2020 Sep 17;10(1):15297. doi: 10.1038/s41598-020-71132-5.
Caesarean sections carry the risk of urinary bladder injury due to formation of adhesions obscuring pelvic planes. Visualizing bladder during retro-fill (cystoinflation) makes it recognizable as it rises into the abdomen taking a tense rounded contour. We conducted a prospective randomized controlled trial to find out whether improved identification of bladder margins by cystoinflation could decrease bladder injury rate and blood loss without causing urological complications. This study included 214 healthy women with previous operative deliveries undergoing elective caesarean section and found to have dense pelvic adhesions. The subjects were randomly allocated into cystoinflation and control groups. Adhesiolysis was performed using bladder retro-fill with 300 cc saline in cystoinflation group, and without retro-fill in control. The bladder injury rate was significantly lower in cystoinflation group compared to control (2.8% vs 20.6%, P < .0001) with lesser blood loss in cystoinflation group (585.33 cc vs 797.10 cc, P < .0001). Mean operative time was similar in both groups. Urinary tract infection and micturition problems occurred more frequently in control group than cystoinflation group (16.8% vs 1.9%, P = .001 and .47 ± 1.63% vs 077 ± .633%, P = .021 respectively) with fistula in one subject compared to none in cystoinflation group. In this study, cystoinflation was effective to significantly reduce bladder injury rate and blood loss. This technique may also prove useful in the fields of surgery, urology and urogynecology.
剖宫产术会由于粘连形成而导致膀胱损伤的风险，这些粘连会掩盖骨盆平面。在膀胱回充（膀胱充气）期间使膀胱可视化，当膀胱上升到腹部并呈现紧张的圆形轮廓时，就可以识别它。我们进行了一项前瞻性随机对照试验，以确定通过膀胱充气是否可以改善膀胱边缘的识别，从而降低膀胱损伤率和出血量，而不会引起泌尿道并发症。这项研究包括 214 名既往有手术分娩史、择期行剖宫产术且发现有致密盆腔粘连的健康妇女。将受试者随机分配到膀胱充气组和对照组。在膀胱充气组中，使用 300cc 生理盐水进行膀胱回充进行粘连松解，而对照组则不进行回充。与对照组相比，膀胱充气组的膀胱损伤率显著降低（2.8%比 20.6%，P<0.0001），且膀胱充气组出血量更少（585.33cc 比 797.10cc，P<0.0001）。两组的平均手术时间相似。对照组比膀胱充气组更常发生尿路感染和排尿问题（16.8%比 1.9%，P=0.001 和.47±1.63%比 077±.633%，P=0.021），且对照组有一例瘘管，而膀胱充气组无。在这项研究中，膀胱充气术可有效降低膀胱损伤率和出血量。该技术在外科、泌尿科和泌尿妇科领域也可能证明有用。
