Incidence and risk factors of Bladder Injury in Cesarean Section and its Management at Tanta University Hospitals

Background: Cesarean delivery is the most frequent procedure conducted globally. The increasing incidence of CS is presumably linked to both the scheduled primary cesarean deliveries requested by Pregnant women and the diminishing prevalence of vaginal births after previous cesarean deliveries. Urological injuries constitute the most common injuries occurring during CS, with the urinary bladder identified as the organ most susceptible to injury owing to its anatomical proximity to the uterus. Numerous potential risk factors for bladder injury have been identified and discussed in the literature. This research sought to assess the prevalence and the risk factors correlated with various types of bladder injuries. Patients & Methods: Out of 1194 pregnant women who underwent CS at Tanta University Hospitals from July 2023 to July 2024, cases of bladder injury were selected. Cross-sectional study design was adopted. 30 women with bladder injuries were included in this study. Results: The prevalence of the reported bladder injuries was 2.5%. No bladder injuries were reported in primigravida, among women with a history of cesarean sections, 13.3% experienced bladder injuries after one previous CS, 23.3% after two previous CS, 43.3% after three previous CS, and 20% after more than three previous CS. Fortythree percent of injured women had a normally situated placenta, and 56.7% had placenta previa/accreta spectrum (PAS). 33.3% of cases underwent scheduled CS, while 66.6% underwent emergent CS. Regarding the uterine site of CS incision, upper uterine segment CS was conducted in 63.3% of cases, and lower uterine segment CS was conducted in 36.7% of cases. Bladder injuries incidentally occurred in 13.3% of injured women during peritoneal opening, 36.7% during uterine incision, 33.3% during bladder dissection, and 16.7% during manual uterine incision extension. The bladder dome was the most prevalent site of bladder injury (70%), posterior wall injury in 26.7%. Correlation of different risk factors with different bladder injury was done. For the all bladder Injury: The site of uterine incision and timing of bladder injury have the strongest positive correlations, meaning they are the most significant risk factors for bladder injuries at all sites. For the bladder dome Injury: The timing of bladder injury and site of uterine incision have the strongest negative correlations, meaning they are the most significant protective factors against dome bladder injuries. Conclusions: The success of bladder repair outcomes was significantly influenced by the intraoperative diagnosis and treatment of bladder injury. Major risk factors for bladder injury included previous