Abstract
Introduction and hypothesis
To determine the incidence of lower urinary tract (LUT) injury at the time of Cesarean delivery (CD) and to identify factors associated with LUT injury.
Methods
Cases of LUT injury at delivery between 2001 and 2012, were identified by ICD-9 code. Chart review was utilized for verification and descriptive data collection. LUT injury incidence rates were calculated using annual delivery totals and trends over time were calculated using simple linear regression. LUT injury was classified as full-thickness bladder injury (including ureteral injury) or partial-thickness bladder injury based on degree of injury and post-operative intervention. Each case was year-matched to generate two CD controls. Logistic regression analysis was performed using maternal, delivery, and health system characteristics to identify factors associated with full or partial injury. Appropriate statistical analyses were performed with significance at p < 0.05.
Results
Overall delivery and CD rates increased during the study time period, but despite the increase in CD rates, annual rates of LUT injury did not vary significantly (p = 0.658). Of the 72 LUT injuries reported, 39 (54 %) were full-thickness bladder, 2 (3 %) ureteral, and 31 (43 %) were partial-thickness bladder injuries. Full injury, controlling for repeat CD, was associated with increasing maternal age, transfusion, and active second stage of labor. Partial injury, was associated with increasing maternal age and delivery in the first half of the academic year.
Conclusions
Despite an increasing volume of CDs, LUT injury remained relatively uncommon (0.3 % of all CDs). Full and partial bladder injuries have unique risk profiles.
Similar content being viewed by others
References
Frankman EA, Wang L, Bunker CH, Lowder JL (2010) Lower urinary tract injury in women in the United States, 1979–2006. Am J Obstet Gynecol 202(5):495.e1–495.e5
Martin J, Hamilton B, Ventura S, Osterman M, Wilson E, Mathews T (2012) Births: final data for 2010. National Vital Statistics Report, 1–61
Simon AE, Uddin SG (2013) National trends in primary cesarean delivery, labor attempts, and labor success, 1990–2010. Am J Obstet Gynecol 1:e1–e8
Cahill AG, Stout MJ, Stamilio DM, Odibo AO, Peipert JF, Macones GA (2008) Risk factors for bladder injury in patients with a prior hysterotomy. Obstet Gynecol 112(1):116–120
Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL (2005) Risk factors for bladder injury during cesarean delivery. Obstet Gynecol 105(1):156–160
Rahman MS, Gasem T, Al Suleiman SA, Al Jama FE, Burshaid S, Rahman J (2009) Bladder injuries during cesarean section in a University Hospital: a 25-year review. Arch Gynecol Obstet 279(3):349–352
Ozdemir E, Ozturk U, Celen S, Sucak A, Gunel M, Guney G, Imamoglu MA, Danisman AN (2011) Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations. Clin Exp Obstet Gynecol 38(3):217–220
Rajasekar D, Hall M (1997) Urinary tract injuries during obstetric intervention. Br J Obstet Gynaecol 104(6):731–734
Nawaz FH, Khan ZE, Rizvi J (2007) Urinary tract injuries during obstetrics and gynaecological surgical procedures at the Aga Khan University Hospital Karachi, Pakistan: a 20-year review. Urol Int 78(2):106–111
Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T (2004) Multiple cesarean section morbidity. Int J Gynaecol Obstet 87(3):227–232
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM (2006) National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107(6):1226–1232
Marshall NE, Fu R, Guise JM (2011) Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 205(3):262.e1–262.e8
Eisenkop SM, Richman R, Platt LD, Paul RH (1982) Urinary tract injury during cesarean section. Obstet Gynecol 60(5):591–596
Gungorduk K, Asicioglu O, Celikkol O, Sudolmus S, Ark C (2010) Iatrogenic bladder injuries during caesarean delivery: a case control study. J Obstet Gynaecol 30(7):667–670
Erez O, Novack L, Kleitman-Meir V, Dukler D, Erez-Weiss I et al (2012) Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity. Int J Womens Health 4:93–107
American College of Obstetricians and Gynecologists (2007) ACOG Committee Opinion No. 372. The role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol 110:221–224
Acknowledgements
We would like to thank Andrea Aber, Clinical Systems Analyst for Magee-Womens Hospital of UPMC, for her assistance with data collection for this project.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oliphant, S.S., Bochenska, K., Tolge, M.E. et al. Maternal lower urinary tract injury at the time of Cesarean delivery. Int Urogynecol J 25, 1709–1714 (2014). https://doi.org/10.1007/s00192-014-2446-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-014-2446-2