A woman has repeat cesarean section. Intraoperatively, an inadvertent cystotomy is made. The PREFERRED repair technique and timing is:
- A Primary repair in two layers with 3-0 absorbable suture at the time of surgery ✓
- B Catheter drainage for 7 days without formal repair
- C Delayed repair at 6 weeks postpartum after resolution of edema
- D Repair with non-absorbable suture and suprapubic catheter for 21 days
Correct answer: A. Primary repair in two layers with 3-0 absorbable suture at the time of surgery
Explanation
Intraoperative cystotomy during cesarean section, when identified immediately, should be repaired primarily at the same operation. Standard repair is in two layers using 3-0 delayed absorbable suture (polyglycolic acid or similar), watertight closure, followed by bladder distension test with methylene blue or sterile milk to confirm integrity. Postoperative catheter drainage for 5–7 days is standard. Delayed repair is not appropriate for clean, recognized injuries. Non-absorbable sutures are not used in bladder repair.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.