title: Bladder injuries during cesarean section in a University Hospital: a 25-year review.
abstract: OBJECTIVE
  The objective was to determine the prevalence of bladder injury during cesarean section (CS) and identify the risk factors causing these injuries, their management and the outcome.
  
  
  METHODS
  We retrospectively reviewed the medical records of all the patients who had bladder injury during CS over a period of 25 years (1983-2007) at the King Fahad Hospital, Al-Khobar, Saudi Arabia. Demographic data, obstetric, surgical details, mechanism of injury, anatomic location, diagnosis, management and outcome were assessed.
  
  
  RESULTS
  Thirty-four cases of bladder injury were identified among 7,708 cesarean deliveries performed during this period with an overall incidence of 0.44%. Primary CS was found in 41.2% of the patients and 58.8% had repeat CS giving an incidence of 0.27 and 0.81%, respectively. Bladder injury occurred when surgical difficulties were encountered during opening of the peritoneal cavity and while developing the bladder flap over the lower uterine segment, mainly due to adhesions and scar tissue resulting from previous abdominal surgery. All the bladder injuries were recognized intraoperatively and repaired with an overall satisfactory outcome. Repeat CS and presence of adhesions were found to be statistically significant risk factors in the study, while operator experience and emergency nature of the CS were considered risk factors in a few cases of bladder injury.
  
  
  CONCLUSIONS
  Data presented in this study indicates that bladder injury when adequately repaired is rarely associated with any complications. Multiple cesarean deliveries is a significant risk factor for bladder injury at the time of repeat CS and patients should be counseled regarding this risk before surgery.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. sabdkader@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Rahman
authors.forename: Turki
authors.initials: T
authors.lastname: Gasem
authors.forename: S A
authors.initials: SA
authors.lastname: Al Suleiman
authors.forename: Fathia E
authors.initials: FE
authors.lastname: Al Jama
authors.forename: Sameera
authors.initials: S
authors.lastname: Burshaid
authors.forename: Jessica
authors.initials: J
authors.lastname: Rahman
mesh_terms: D001724:Birth Weight; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D001743:Urinary Bladder / Q000293:injuries*