Iatrogenic bladder perforations: longterm followup of 65 patients

BACKGROUND: We reviewed our experience with bladder perforations to better understand the causes of these injuries and to describe their management and its effect on longterm outcomes. STUDY DESIGN: Our bladder trauma database yielded 65 patients during a 12-year period, followed for a mean of 36 months, who had sustained iatrogenic bladder perforations. Endourologic procedures were excluded. Demographic data, surgical details, mechanism of injury, anatomic location, grading, diagnosis, management, and outcomes were assessed. RESULTS: Gynecologic procedures accounted for 40 perforations (61.5%), general surgical procedures for 17 (26.2%), and urologic procedures for 8 (12.3%). The type of gynecologic surgery included abdominal hysterectomy in 16 (40%), resection of a pelvic mass in 12 (30%), cesarean section in 10 (25%), and diagnostic laparoscopy in 2 (5%). Of the general surgical procedures, eight were for colon cancer (47.1%), six for diverticulitis (35.3%), and three for inflammatory bowel disease (17.6%); of the urologic injuries, six occurred during vaginal surgery and two during laparoscopy. Predisposing factors were identified in 52 patients (80%). Intraoperative urologic consultation was obtained in 63 of 65 patients, with prompt identification and repair. In two cases a concurrent left ureteral injury was identified and managed by reimplantation. The sole complication was a vesicovaginal fistula 2 months postoperatively, so the success rate for repair was 98.4%. CONCLUSIONS: Although infrequent, iatrogenic bladder perforations can occur during any pelvic, abdominal, or vaginal procedure. Prompt intraoperative recognition is paramount to ensure satisfactory outcomes. Adequate repair usually can be achieved simply by vesicorrhaphy, limiting unnecessary extravesical dissection. With this approach, morbidity can be minimized.