Clinical management of bladder injury 1. Those with intraoperative bladder injury should be repaired immediately, the bladder fissure should be closed with 2-0 absorbable sutures in full layers, and the catheter should be left in place for 7-10 days after surgery to keep the urinary catheter unobstructed. For larger bladder wounds, a cystostomy tube should be placed to adequately drain urine.
2, bladder injury found early after surgery should be immediately explored and repaired, and attention should be paid to thorough drainage of extravasated urine and application of antibiotics to prevent infection, and the urinary catheter should be retained for 10-14 days after surgery.
For inflammatory masses formed by extravasation of urine found several months after surgery, the inflammatory masses and the affected bladder wall should be removed and the bladder repaired with sutures while using antibiotics to prevent infection or after the inflammation is controlled.
4, for patients with vesicovaginal fistula, vesicovaginal fistula repair should be performed after 3 months postoperatively.
Prevention of bladder injury 1. Preoperative diagnosis should be as clear as possible, understanding the relationship between the lesion and the bladder, strictly grasp the surgical indications, the scope of surgery and the surgical style, and fully estimate the surgical difficulties. For those suspected of having lesions involving the bladder, cystoscopy should be performed before surgery to understand whether the bladder is involved and the location and extent of involvement. The operator should have a good grasp of the local anatomical relationship of the pelvis.
2. During intraoperative exploration, attention should be paid to identifying the relationship between the pelvic organs and the lesion and understanding whether there are any abnormalities in the urinary tract organs. When performing hysterectomy, the bladder should be pushed away from the outer cervical opening, and when suturing the vaginal stump, ensure that the suture does not penetrate the bladder wall, and do not blindly suture the posterior bladder wall and deep tissue of the uterine cervix.