Bladder injury

Urgent call over to gynac ot  for this suspected case of bladder injury during total abdomen hysterectomy surgery.

How to manage intraoperative?
How to manage post operatively? intraoperative picture attached

Bladder injuryBladder injuryBladder injury


  • Gyanendra Sharma
    Gyanendra Sharma
    20 Mar 2020 10:33:12 PM

    I am sure Dr. Majumdar has managed this injury very efficiently

    For the benefit of trainees i am providing a link of my talk on urological injuries in Gynecological surgeries 38cQgT0g
    Hope the trainees find the talk useful

  • Gyanendra Sharma
    Gyanendra Sharma
    20 Mar 2020 10:36:28 PM

    Also if one goes to on YouTube -- there are many videos on bladder injury and it's management

    Hope they are of some use to the trainees

  • Dr Prashant Mulawkar
    Dr Prashant Mulawkar
    20 Mar 2020 11:21:03 PM

    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 ureteric jets?


    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 drain.

    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 leak.

    Prashant Mulawkar

  • Gyanendra Sharma
    Gyanendra Sharma
    21 Mar 2020 07:14:31 AM

    Distension of bladder to find a suspected injury or look for leak should be around 400 ml 

    Distending the bladder to only around 200 to 250 ml would lead to missing many injuries or leaks

  • Dr. Anil Takvani
    Dr. Anil Takvani
    21 Mar 2020 07:22:52 AM

    I almost agree with Prashant,  but never ever done methelyne blue leak test.  Probably that is not necessary. 

    And as he has mentioned likey to spoil the field to look for associated issues smaller injuries and bleeding at times. 
    Yes I may prefer Suprapubic catheter in addition to per urethral catheter for atlest couple of days post operative if injuries are multiple with some continues oozing.... 

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    21 Mar 2020 10:05:21 AM

    Thank u sir...45 years old lady operated for fibroid uterus.Patinet hemodynamically stable .No associated injury..Didn't open the can't comment on jet

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    21 Mar 2020 11:43:43 AM

    Sir..what modifications in surgery u would have made if bladder neck was involved in this case?

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    23 Mar 2020 01:50:49 PM

    Did a single layer muscle repair with greater omentum trasnfixation over the repair...

    Kept on cath for 12 days...
    Did cystogram on 12 extravasation of attached.
    Foley cath removed

  • Raju Ranjan
    Raju Ranjan
    01 Apr 2020 02:03:29 PM

    That you tube link of talk on bladder injuries is not working....

    Please rectify and resend it.

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