Urinary tract injury during cesarean section.

Lower urinary tract injury at the time of cesarean section is an uncommon complication. During a 5-year period, the incidence of bladder and ureter injuries at the Los Angeles County/University of Southern California Medical Center was .31 and .09%, respectively. When bladder injury occurs, it usually is due to surgical difficulty encountered while developing the bladder flap over the lower uterine segment. The difficulty is caused usually by scar tissue from previous surgery. Ureteral injury is a rare complication of cesarean section. It is attributable most often to ureteral transection or ligation associated with uterine incision extensions in the lower uterine segment or the vagina, and to attempts to achieve hemostasis. The data presented in this report indicate that cystotomy, when adequately repaired, is not associated with any complications. Furthermore, diagnostic cystotomy with intravenous injection of indigo carmine is a rapid, safe method of evaluating ureteral patency.