Symptoms of bladder injury

summary

Laparoscopic surgery has been widely carried out in gynecology, and this kind of surgery may cause urinary system injury, mainly including bladder and ureter injury, the incidence rate is 0.1% ~ 0.2%. When the normal anatomic position of bladder changes for various reasons, bladder injury is easy to occur in laparoscopic surgery. Air acupuncture and trocar can cause injury. Short stature and children have higher risk of injury. Let's talk about the symptoms of bladder injury.

Symptoms of bladder injury

During laparoscopic operation, the bladder may be seen or suspected to be damaged by cannula or other injuries. At this time, the excreted urine is bloody and the urine volume is reduced, and the urine can be seen leaking into the pelvic cavity, or the cannula can be seen passing through the bladder close to the anterior abdominal wall. If injury is suspected, sterile milk or diluted methylene blue dye can be retrogradely injected into the bladder through the balloon catheter to observe whether there is urine leakage.

5 ml indigo carmine or methylene blue dye can also be injected intravenously to observe whether there is leakage in the bladder, or cystoscopy can be performed to observe whether the cannula is penetrated into the bladder. Cystography should be performed if injury is suspected but not confirmed by the above methods. In the process of laparoscopy, if the diagnosis of small bladder injury, the continuous drainage with balloon catheter can mostly heal itself; For large injuries, laparotomy is needed to repair.

There are some typical symptoms of bladder injuries that are neglected in surgery, as well as those caused by electricity or laser. If there is reduced urine output, hematuria, suprapubic pain, and fullness, bladder injury should be suspected. In addition, due to the reabsorption of urine in abdominal cavity, blood urea nitrogen can be significantly increased. Abdominal drainage fluid examination may find abnormal levels of urea nitrogen and uric acid, which is due to the infiltration of urine into the abdominal cavity.

matters needing attention

(1) When separating retroflexure of bladder peritoneum, if it is difficult to separate because of scar adhesion (after cesarean section) and unclear boundary, attention should be paid not to separate forcibly. The bladder can be separated from the loose tissue in the lateral fossa of the bladder on both sides of the cervix to the inside, and the bladder can be separated from the surface of the cervix first, and then the scar can be left, and the sharp separation should be used（ 2) When using electrocoagulation to treat the lesions on the surface of bladder, do not electrocoagulate excessively, so as to avoid thermal damage to the bladder（ 3) In the process of laparoscopic hysterectomy (LTH) or LAVH, the uterus should be pushed upward as far as possible, and a gauze ball should be used to lift the vaginal wall from the anterior fornix of the vagina, so as to separate and push the bladder downward, so as to make the boundary of the bladder clearer; The use of cup-shaped uterine lifter is conducive to the separation of bladder from cervical and anterior vaginal wall.