Bladder injury correction following cesarean section: surgical approaches and outcomes – a literature review

• DOI: https://doi.org/10.22533/at.ed.15953125300914

• Palavras-chave: Cesariana; lesão vesical; complicações urológicas; reparo cirúrgico; desfechos maternos; espectro da placenta acreta.

• Keywords: Cesarean section; bladder injury; urological complications; surgical repair; maternal outcomes; placenta accreta spectrum.

• Abstract: Background: Bladder injury is an uncommon but clinically significant complication of cesarean delivery. Although its incidence is relatively low, such injuries are associated with increased maternal morbidity, prolonged hospitalization, and long-term sequelae including fistula formation and voiding dysfunction. The rising global rate of cesarean sections and the increasing prevalence of placenta accreta spectrum highlight the importance of prevention, prompt recognition, and effective surgical management. Objective: This review aims to summarize the current literature on the epidemiology, risk factors, diagnosis, surgical repair techniques, postoperative management, and outcomes of bladder injury during cesarean delivery, with emphasis on areas of consensus, controversy, and gaps in evidence. Methods: A narrative literature review was performed using PubMed, Embase, Scopus, and Cochrane Library. Studies published in English up to March 2025 were included if they addressed diagnosis, surgical correction, or outcomes of bladder injury at cesarean delivery. Original articles, retrospective series, systematic reviews, and relevant randomized trials were analyzed, while isolated case reports and non-obstetric bladder injuries were excluded. Results: Twelve key studies were identified and synthesized. Prior cesarean delivery, adhesions, and placenta accreta spectrum emerged as the strongest risk factors. Intraoperative recognition, aided by cystoscopy or dye tests, is the most important determinant of favorable outcomes. Primary closure with absorbable sutures remains the standard repair technique, with adjunctive measures such as omental interposition or ureteral stenting reserved for complex cases. Postoperative management typically involves 7–14 days of bladder drainage, with selective use of imaging prior to catheter removal. When injury is diagnosed and repaired intraoperatively, maternal outcomes are excellent, whereas delayed recognition significantly increases morbidity and the risk of fistula. Conclusion: Bladder injury during cesarean delivery, though rare, carries substantial implications for maternal health. Early recognition and immediate repair are critical to favorable outcomes. Despite advances, controversies remain regarding technical details of closure, optimal catheter duration, and the role of minimally invasive approaches. Future multicenter studies and standardized guidelines are needed to harmonize management and improve patient-centered care.