Urinary bladder injuries in obstetric and gynecologic procedures

Twenty urinary bladder injuries in 18 patients as a result of obstetric and gynecologic operations are presented. Recognition of all the injuries was delayed, and they occurred as vesicovaginal or vesicouterine fistulas. Eighteen (90%) of these injuries resulted in vesicovaginal fistulas, and 2 (10%) caused vesicouterine fistulas. The repair procedures included 4 Latzko partial colpocleises, 5 vaginal repairs, 2 vaginal flap techniques, 3 transperitoneal transvesical approaches, 1 indwelling Foley catheterization, 1 endoscopic fulguration for vesicovaginal fistula, and 2 transperitoneal extravesicle approaches for vesicouterine fistulas. All but 2 were successful (90%). The 2 exceptions required a vaginal repair with a Martius graft and a transvesical repair with omental interposition. This study reconfirmed that a good outcome can be achieved in most cases by a careful preoperative examination and prudent selection of fresh, well-vascularized tissue for interposition during the operation.