Urinary tract injuries in obsteric practice

ABSTRACT

Caesarean section and other obstetrical procedures, are inherently more hazardous than spontaneous vaginal delivery. In this one year study conducted at two teaching hospitals eight patients, sustained injury to the urinary bladder making an incidence of 0.43%. Seven [87.5%] patients sustained bladder injury during lower segment caesarean section[LSCS] while one [12.5%] received it through forceps application. There was no ureteric injuries. In four [50%] patients the LSCS was carried out for obstructed labour. Three [37.5%] patients sustained injury during a second or subsequent caesarean section. One [12.5%] patient developed a vesico-vaginal fistula after instrumentation. Bladder closure in 2 layers was carried out in 5 [62.5%] cases and in one layer in 2 [25%] cases. Primary repair of bladder was successful in 6 [75%] cases of bladder injury. There was one mortality [12.5%] due to anuria and septicaemia. The mean hospital stay was 15.9 +/- 11.15 days. Supervision and structured training of resident is essential in minimising complications