Urgent call over to gynac ot for this suspected case of bladder injury during total abdomen hysterectomy surgery.
I am sure Dr. Majumdar has managed this injury very efficiently
Also if one goes to edmedonline.com on YouTube -- there are many videos on bladder injury and it's management
Hi Dr. Tikenjit Mazumdar
Thank you very much for the case. Before we opine we need to
know a few things like
age of the patient,
indication for hysterectomy Like Malignancy, Endometriosis
Risk factors like Prior pelvic surgery, previous LSCS,
Is the patient haemodynamically stable?
Is there any associated injury? Is it possible to see the
Another suggestion would be label the photographs that are
provided as to which is head end which is foot end of the patient. Was it a
vertical or transverse incision?
Of course, External bladder perforations that are recognised
intraoperatively should be closed with two-layer bladder repair (LE: A).
Absorbable sutures should be used. Most commonly 3-0 PGA is used.
Once you have repaired it, make sure that you can distend
the bladder with saline. If there is no manor leak, you would be able to
distend the bladder. Once you have ruled out major leak, distend the bladder
with methylene blue. This will rule out minor leak. If you distend the bladder
with methylene blue in presence of major leak, the field becomes blue and tissues
are difficult ti identify in case you have to take some more sutures.
If the quality of repair is good, there is no need to keep a
Bladder drainage for 7-14 days should be kept
post-operatively. This can be either urethral or suprapubic. I personally
prefer suprapubic catheter.
I usually do not do post-operative cystograms to check for
Distension of bladder to find a suspected injury or look for leak should be around 400 ml
I almost agree with Prashant, but never ever done methelyne blue leak test. Probably that is not necessary.
Thank u sir...45 years old lady operated for fibroid uterus.Patinet hemodynamically stable .No associated injury..Didn't open the bladder...so can't comment on jet
Sir..what modifications in surgery u would have made if bladder neck was involved in this case?
Did a single layer muscle repair with greater omentum trasnfixation over the repair...
That you tube link of talk on bladder injuries is not working....