title: Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution.
abstract: OBJECTIVE
  To analyze the etiology, diagnosis, and long-term outcomes of iatrogenic nonendoscopic bladder injuries over a 24-year period.
  
  
  METHODS
  All iatrogenic bladder injuries were entered prospectively into our database from 1990 to 2014. Information gathered included causative procedure, injury characteristics, management, and outcome.
  
  
  RESULTS
  A total of 127 patients with nonendoscopic iatrogenic bladder injuries were included (111 women [87%], 16 men [13%]; mean age 51 years [range, 23-84]). Risk factors were identified in 92 patients (79%) including prior surgery, inflammation, and extensive tumor. Obstetric-gynecologic surgery accounted for most injuries (65%), with hysterectomy the most common procedure, followed by cesarean section. General surgery and nonendoscopic urologic injuries accounted for 22% and 13% respectively. Most injuries occurred during open surgery (77%) compared with vaginal (12%) and laparoscopic surgeries (11%). Laparoscopic surgery was associated with a delay in diagnosis, P=.002. Bladder injuries with concomitant ureteral injuries were more likely to have long-term complications, P=.001.
  
  
  CONCLUSIONS
  In analyzing iatrogenic bladder injuries at our institution over 24 years, we observed that hysterectomy and cesarean sections were the 2 most common causative procedures. A delay in diagnosis was more likely to occur during laparoscopic surgery. Complications occurred more commonly with a concomitant ureteral injury.
authors.affiliation: Department of Urology, Lenox Hill Hospital, New York, NY. Electronic address: billycordon@gmail.com.
authors.forename: Billy H
authors.initials: BH
authors.lastname: Cordon
authors.affiliation: Department of Urology, Lenox Hill Hospital, New York, NY.
authors.forename: John A
authors.initials: JA
authors.lastname: Fracchia
authors.affiliation: Department of Urology, Lenox Hill Hospital, New York, NY.
authors.forename: Noel A
authors.initials: NA
authors.lastname: Armenakas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D001743:Urinary Bladder / Q000293:injuries*; D055815:Young Adult