Bladder Wall Perforation or Traumatic Injury
The bladder, like any other part of the human body, can be injured. This can occur during routine surgery procedures, particularly hysterectomy. The bladder can be accidentally cut, requiring immediate surgical report. In other cases, a suture may accidentally penetrate the bladder wall without the knowledge of the surgeon. Cystoscopy to visualize the bladder wall and verify that no injury has occurred is commonly performed after hysterectomy.
We have worked with two patients who had sutures embedded in the bladder wall. One of the more interesting cases was a retired physician who began experiencing bladder symptoms of frequency, urgency and pain. She first noticed pain while running that, over time, worsened. After a simple diagnostic workup, her urologist suggested that her symptoms were all in her head and provided very little in the way of treatment. One day she experienced a sudden need to push during urination which resulted in a row of blue stitches dropping into the toilet bowl in her urine. Stunned, she absolutely recognized them as stitches but could not figure out why they were there. A short time later, her condition worsened again and became so severe that she could barely walk. Her physician performed an exploratory laparoscopy and, to their amazement, discovered that her abdomen was full of floating, blue polypropylene stitches that were attaching themselves to various tissues and organs, causing inflammation. She later recalled that she had had a tummy tuck after pregnancy 20 years earlier and allowed a resident to perform her surgery. Unfortunately, the resident used the wrong stitches internally. All stitches were eventually removed and her symptoms resolved.
Patients who are experiencing complications due to vaginal mesh surgery have reported that the mesh can migrate through urinary tract tissues, including the urethra and bladder.
Some bladders have ruptured due to deliberate lack of restroom access. Tragically, this has occurred to some patients who are driving for long distances and are denied restroom stops, often in younger children. The bladder has also ruptured in some patients undergoing hydrodistention with cystoscopy due to overfilling or a very weakened bladder wall.
Lower abdominal injury can also result in bladder damage. One well documented case was a young soccer player who was playing with a full bladder when they were hit in their lower belly by a soccer ball. Due to the pressure on the full bladder, the bladder wall ruptured.
Surgical repair is often required.