Bladder Injury

This chapter addresses the management of bladder injuries in open surgery. Risk factors for bladder injury include obesity, inadequate incision, large pelvic masses, congenital abnormalities, endometriosis, extensive pelvic dissection, bleeding from bladder base, previous pelvic surgery or cesarean section, malignancy, and radiotherapy. The principles of bladder repair are tension-free approximation of bladder mucosa and muscularis, and continuous unobstructed bladder drainage. It is often necessary to extend the bladder incision or injury to better define the extent of the damage and to assess the base of the bladder and the ureters. Postoperatively, if excessive clear fluid is observed in the pelvic drain, a leaking bladder or an unrecognized ureteric injury needs to be considered. A high index of suspicion for bladder injury, deliberate check of the anatomy, and early recourse to necessary investigations are the keys to minimize complications.