Treatment of Iatrogenic Thermal Bladder Injury

Injuries to the urinary tract are a frequent occurrence during gynecological procedures, particularly laparoscopic hysterectomy, with acute and chronic complications being reported. Urinary tract injuries occur in about 0.73% of laparoscopic hysterectomies, similar to abdominal hysterectomy rates. These injuries can lead to significant complications, including the formation of vesicovaginal (3.4%) and ureterovaginal (2.4%) fistulas, often requiring additional surgery. Bladder injuries are more prevalent than ureteral injuries. Bladder injury rates range from 0.5% to 0.66%, with Ureteral injuries ranging from 0.02%-0.4%. Thermal bladder injuries can occur due to the use of electrosurgery near the bladder. The spread of electrothermal injuries is greater than the initial area of blanching, creating a significant area of necrosis. Consequently, intraoperative detection of such injuries is challenging and the depth of injury is difficult to assess even if detected. This case report describes a 34-year-old woman who experienced a thermal bladder laceration during a laparoscopic supracervical hysterectomy with sacrocolpopexy for a symptomatic grade II lateral cystocele, grade I uterine descensus and adenomyosis. Two weeks after the operation, the patient presented with bladder pain of varying intensity. After ruling out a urinary tract infection, a cystoscopy was performed which revealed a 1 cm thermal injury to the posterior wall of the bladder. Conservative treatment with NSAIDs was recommended as well as subsequent cystoscopy. At the 4-week follow-up, complete resolution was observed with no further evidence of injury. To our knowledge, there are no similar cases in the literature which were successfully treated without any surgical intervention. However, there are studies that recommend debridement prior to repairing all thermal bladder injuries, regardless of their size. This case highlights firstly the importance of caution when using electrosurgery and provides successful conservative management of iatrogenic thermal injury.