European Journal of Cardiovascular Medicine

Introduction: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital. Caesarean section is a live saving procedure but when performed without appropriate indications can add risk to both mother and baby. As per WHO report, at population level, Caesarean section rates higher than 10% are not associated with reductions in maternal and new-born mortality rates. In India as per District level household survey 3 (DLHS) Caesarean section rate is 28.1% in private sector and 12% in public sector health care facilities. The close embryonic development and anatomical proximity of the urinary bladder and genital organs, are responsible for the urinary tract to injury during surgical procedures in the female pelvis. During LSCS bladder injury is demonstrated by the presence of gas filling up the Foley bag or visibly bloody urine in the Foley bag. Veress needle injuries and other small injuries to the bladder can be successfully managed conservatively by catheter drainage for seven to 14 days followed by cystography while large bladder injuries, such as from 5- or 10-mm trocar or surgical dissection usually require suturing the injuries closed. Risk factors for bladder injury during LSCS include previous operations, exposure to radiation, malignancy, chronic infection, and inflammation.  Aims and objectives- The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2021 to December 2022. Cases with the documented urological injuries during these procedures were analysed further Material And Methods: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2021 to December 2022, there were 3000 LSCS done in the department of Obstetrics and gynaecology, GMC Shahdol in the given study period.  In suspected cases of bladder injuries cystogram X-ray of the bladder after injection of contrast medium is performed. For extraperitoneal injuries (grade 2) without complicating factors, treatment is a insertion of Foley catheter for 7 - 14 days. grade 3 to grade 5 injuries generally require operative repair. Closed suction drains should be left in place after repairs. Suprapubic tube placement is not necessary in most cases. For injuries to the ventral bladder, dome, or posterior bladder, the mucosa is closed in a running fashion using 3-0 vicryl followed by a seromuscular running suture of 2-0 vicryl. The bladder is irrigated to ensure a watertight closure. A third layer in a Lembert fashion can be used in cases at high risk for fistula formation or when a leak is identified. In the laparoscopic setting, a one-layer closure is performed using 2-0 vicryl to close all layers of the bladder. An additional layer can then be added using a 2- 0 vicryl in a Lembert fashion for more extensive injuries.  Results: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2018 to December 2019, there were 3000 LSCS done in the department of Obstetrics and gynaecology, GMC Shahdol in the given study period. In this study mean age of bladder injury is 34.8 years and for ureteric injury 35 years. Parity for bladder injury 2.4 and for ureteric injury 3. Gestational age is similar for both is 37 weeks. In this study there are 2990 LSCS done and 10 peripartum hysterectomy done. Among all patients who underwent cesarean section 1.5% suffered from bladder injury, 0.01% ureteric injury and 0.01% for ureteric and bladder injury. Similarly, in peripartum hysterectomy, 40% suffered from bladder injury and no one have ureteric injury. Total 52 [1.5%] cases have injury. Among all patients who suffered from bladder injury, mostly cases are primigravida cases, which are 57% cases. 13% cases are more than two section patients. Others are previous two section 9%, Placenta previa and placenta accreta 7.6%, Previous history of myomectomy and hysterotomy 3.8% and 1.9% cases from 2nd stage labour and CPD patients. In bladder injury, most of the cases are bladder dome [81.5%], posterior wall [14%], lateral wall [4%] cases and none cases in bladder neck injury.  Most bladder injury repaired by triple layers vicryl with SPC insertion [44%], without SPC [38%] and only catheterization only 11% cases. All ureteric injury repaired by DJ stent insertion with repair. SPC removed after 14 days. Conclusion: 1.5% of the bladder injuries were observed. Early detection and prompt management of bladder injury can decrease the morbidity and mortality in LSCS cases. The incidence urological injuries during obstetrics and gynaecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.