BLADDER INJURY CORRECTION FOLLOWING CESAREAN SECTION: SURGICAL APPROACHES AND OUTCOMES – A LITERATURE REVIEW

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

• Palavras-chave: Cesarean section; bladder injury; urological complications; surgical repair; maternal outcomes; spectrum of placenta accreta.

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

• Abstract: Introduction: Bladder injury is an uncommon but clinically relevant complication of cesarean section. Although its incidence is relatively low, such injuries are associated with increased maternal morbidity, prolonged hospital stay, and long-term sequelae, including fistula formation and urinary dysfunction. The global increase in cesarean section rates and the growing prevalence of placenta accreta spectrum disorders underscore the importance of prevention, early diagnosis, and effective surgical management. Objective: This article aims to review the current literature on the epidemiology, risk factors, diagnosis, surgical repair techniques, postoperative management, and outcomes of bladder injuries during cesarean section, with an emphasis on areas of consensus, controversy, and gaps in knowledge. Methods: A narrative review of the literature was performed using the PubMed, Embase, Scopus, and Cochrane Library databases. Studies published in English up to March 2025 that addressed diagnosis, surgical correction, or outcomes of bladder injury during cesarean sections were included. Original articles, retrospective series, systematic reviews, and relevant randomized clinical trials were analyzed, excluding isolated case reports and non-obstetric bladder injuries. Results: Twelve key studies were identified and analyzed. Previous cesarean sections, adhesions, and placenta accreta spectrum were the main associated risk factors. Intraoperative recognition, aided by cystoscopy or dye tests, is the main determinant of a good prognosis. Primary closure with absorbable sutures remains the standard technique, with adjuvant measures, such as omentum interposition or ureteral catheterization, reserved for complex cases. Postoperative management usually involves 7 to 14 days of bladder drainage, with selective use of imaging tests before catheter removal. When the injury is diagnosed and repaired intraoperatively, maternal outcomes are excellent, while late diagnosis significantly increases morbidity and the risk of fistula. Conclusion: Bladder injury during cesarean section, although rare, has a substantial impact on maternal health. Early diagnosis and immediate repair are essential for good outcomes. Despite advances, there are still controversies regarding the technical details of closure, the ideal duration of catheterization, and the role of minimally invasive approaches. Multicenter studies and standardized guidelines are needed to standardize management and improve patient-centered care.