Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
Acta Obstet Gynecol Scand. 2023 Dec;102(12):1608-1617. doi: 10.1111/aogs.14641. Epub 2023 Aug 8.
Iatrogenic bladder injury is a rare complication following obstetric and gynecologic surgery and only sparse information is available regarding length of transurethral catheterization following injuries, suturing techniques including choice of suture, and complications. The primary aim of this systematic review was to evaluate length of transurethral catheterization in relation to complications following iatrogenic bladder injury. Second, we aimed to evaluate the number of complications following repair of iatrogenic bladder injuries and to describe suture technique and best choice of suture.
A systematic review and meta-analysis was conducted, and the results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Medline electronic databases were searched, and followed by screening from two independent reviewers. Studies published between January 2000 and March 2023 describing methods of bladder injury repair following obstetric or gynecologic benign surgery were included. Data extraction was done using Covidence. We performed a meta-analysis on complications after repair and explored this with a meta-regression analysis (Metafor package R) on length of catheterization to determine if length of catheterization influenced the risk of complication. A risk of bias tool from Cochrane was used to assess risk of bias and the study was registered in PROSPERO (CRD42021290586).
Out of 2175 articles, we included 21 retrospective studies, four prospective studies, and one case-control study. In total, 595 bladder injuries were included. Cesarean section was the most prominent surgery type, followed by laparoscopically assisted vaginal hysterectomy. We found no statistically significant association between length of transurethral catheterization and numbers of complications following repair of iatrogenic bladder injuries. More than 90% of injuries were recognized intraoperatively. Approximately 1% had complications following iatrogenic bladder injury repair (0.010, 95% confidence interval 0.0015-0.0189, 26 studies, 595 participants, I = 4%).
Our review did not identify conclusive evidence on the length of postoperative catheterization following bladder injury warranting further research. However, the rate of complications was low following iatrogenic bladder injury with a wide range of repair approaches.
医源性膀胱损伤是妇产科手术后罕见的并发症，关于损伤后留置导尿管的时间、缝合技术（包括缝线选择）和并发症等方面的信息非常有限。本系统评价的主要目的是评估医源性膀胱损伤后留置导尿管的时间与并发症之间的关系。其次，我们旨在评估医源性膀胱损伤修复后的并发症数量，并描述缝合技术和最佳缝线选择。
进行了系统评价和荟萃分析，并按照系统评价和荟萃分析的首选报告项目（PRISMA）指南呈现结果。检索了 PubMed、Embase 和 Medline 电子数据库，并由两名独立评审员进行筛选。纳入描述妇产科良性手术后膀胱损伤修复方法的研究，研究时间为 2000 年 1 月至 2023 年 3 月。使用 Covidence 进行数据提取。我们对修复后的并发症进行了荟萃分析，并通过 Metafor 包 R 进行了荟萃回归分析（Metafor 包 R）来确定留置导尿管的长度是否会影响并发症的风险。使用 Cochrane 的风险偏倚工具评估风险偏倚，并在 PROSPERO（CRD42021290586）中进行了研究注册。
在 2175 篇文章中，我们纳入了 21 篇回顾性研究、4 篇前瞻性研究和 1 篇病例对照研究。共有 595 例膀胱损伤。剖宫产是最常见的手术类型，其次是腹腔镜辅助阴道子宫切除术。我们发现，医源性膀胱损伤修复后留置导尿管的时间与并发症的数量之间没有统计学上的显著关联。超过 90%的损伤是在术中发现的。大约有 1%的医源性膀胱损伤修复后出现并发症（0.010，95%置信区间 0.0015-0.0189，26 项研究，595 名参与者，I ²=4%）。
我们的综述没有发现关于医源性膀胱损伤后留置导尿管时间的明确证据，需要进一步研究。然而，医源性膀胱损伤后并发症的发生率较低，修复方法多种多样。
