Preventing Bladder Injury at Hysterectomy in Post-Cesareans

With the increasing cesarean section rates gynecologists are facing more number of cases with previously scarred uterus at the time of hysterectomy. Uterine incision especially of cesarean section leads to bladder adhesions which poses great problem at the time of bladder dissection during hysterectomy and sometimes inadvertently ends up in cystostomy. Greater the number of cesareans, higher is the chances of adhesions and fibrosis. Both vaginal and laparoscopic approach can be utilized effectively just taking few precautions. Urinary bladder if gets injured, one should be able to diagnose it per operatively so that timely management can be done to prevent long term squealae. Here few important points are focused which can help in assessing the difficulty, at risk cases pre-operatively and surgical options to prevent bladder injury at the time of both vaginal and laparoscopic hysterectomy.