Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Matern Fetal Neonatal Med. 2022 Sep;35(18):3547-3554. doi: 10.1080/14767058.2020.1828336. Epub 2020 Oct 4.
Urinary tract injury during cesarean delivery is a rare but severe complication. Due to the high prevalence of cesarean delivery, this injury may pose a high burden of morbidity. We reviewed the cases of lower urinary tract injuries identified during cesarean delivery in a tertiary medical center and identified diagnosis and treatment methods, as well as short and long-term outcomes, to establish a protocol of care for such cases.
We included women with urinary tract injury during cesarean delivery between 2004 and 2018. The cases were identified according to ICD-9 codes, as well as free text in the medical report and discharge letter. Data were collected retrospectively. Telephone interviews were conducted to obtain additional data regarding long-term outcomes.
In14 years, a total of 17,794 cesarean deliveries were performed at our institution (17.5% of all deliveries), 14 cases of bladder injury, and 11 cases of ureteral injury were identified featuring an incidence of 0.08 and 0.06%, respectively. All bladder injuries were diagnosed and repaired intra-operatively. Six (55%) cases of ureteral injury were diagnosed in the post-operative period, and 3 of these patients required further surgery for definitive treatment. None of the patients suffered long-term adverse effects. Most bladder injuries occurred in women with previous cesarean delivery in the presence of abdominal adhesions. In contrast, most ureteral injuries occurred in women with emergency cesarean delivery during the second stage of labor, and were accompanied by an extension of the uterine incision. All women had normal kidney function in follow up and did not suffer from long term sequelae.
Urinary tract injury is an uncommon complication of cesarean delivery. A high index of suspicion is recommended to avoid late diagnosis and complications. We propose a comprehensive protocol for the management of these injuries.
剖宫产术中发生的泌尿道损伤是一种罕见但严重的并发症。由于剖宫产的高发生率，这种损伤可能会造成较高的发病率负担。我们回顾了在一家三级医疗中心进行剖宫产时发现的下泌尿道损伤病例，确定了诊断和治疗方法，以及短期和长期结局，从而为这类病例建立了护理方案。
我们纳入了 2004 年至 2018 年期间在剖宫产术中发生泌尿道损伤的女性患者。根据 ICD-9 编码以及医疗报告和出院信中的文本，识别出这些病例。数据是通过回顾性收集的。通过电话访谈获得了有关长期结局的额外数据。
在 14 年间，我院共进行了 17794 例剖宫产术（占所有分娩的 17.5%），发现 14 例膀胱损伤和 11 例输尿管损伤，发生率分别为 0.08%和 0.06%。所有膀胱损伤均在术中诊断并修复。6 例（55%）输尿管损伤在术后诊断，其中 3 例患者需要进一步手术以确定治疗方案。所有患者均未出现长期不良影响。大多数膀胱损伤发生在有腹部粘连的既往剖宫产妇女中。相比之下，大多数输尿管损伤发生在第二产程行急诊剖宫产的妇女中，且与子宫切口延长有关。所有女性在随访中肾功能正常，未出现长期后遗症。
泌尿道损伤是剖宫产术的一种罕见并发症。建议提高警惕，避免漏诊和并发症。我们提出了一种综合的管理这些损伤的方案。
