The surgical suturing of the bladder is called Cystorrhaphy.
What is Cystorrhaphy?
Cystorrhaphy is the medical term for the surgical repair of a laceration, injury, or rupture in the urinary bladder wall. The name is derived from Greek roots, where “cysto-” refers to the bladder and “-rrhaphy” means to suture or repair. This procedure closes a defect in the bladder tissue to restore its integrity as a urine storage reservoir.
The urinary bladder is a hollow, muscular organ located in the lower pelvis. Its primary function is the temporary storage of urine. The bladder wall is composed of several layers, including the inner urothelium and the outer detrusor muscle layer.
The bladder can stretch to accommodate a significant volume of urine. When the wall’s integrity is compromised, urine can leak into surrounding tissues or the abdominal cavity, necessitating prompt surgical repair. Cystorrhaphy closes this breach, ensuring a watertight seal to prevent complications.
When Bladder Repair is Necessary
Cystorrhaphy is necessary when the bladder wall is breached, often due to severe external forces or complications from other medical procedures. Traumatic injuries, such as blunt force trauma to the lower abdomen (e.g., motor vehicle collisions), are a frequent cause. If the bladder is full, high-energy impact can cause rupture, leading to an intraperitoneal injury where urine spills into the abdominal cavity.
Traumatic injuries associated with pelvic fractures typically result in an extraperitoneal rupture, where urine leaks into the space around the bladder. Penetrating wounds, such as stab or gunshot wounds, also create defects requiring repair. Untreated bladder rupture can lead to serious complications, including peritonitis, sepsis, and fistula formation.
Many bladder injuries are iatrogenic, occurring unintentionally during other surgical procedures. This risk is present during complex pelvic surgeries, such as hysterectomies or C-sections. Other abdominal surgeries near the bladder can also inadvertently cause a laceration, which must be immediately closed with cystorrhaphy.
The Procedure for Suturing the Bladder
The technical execution of cystorrhaphy aims for a durable, watertight closure of the bladder wall defect. The surgical approach depends on the patient’s condition and injury, ranging from traditional open surgery (laparotomy) to less invasive methods. Minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, are increasingly used, offering smaller incisions and faster recovery for stable patients.
Regardless of the access method, the primary goal is a tension-free repair. Surgeons typically use absorbable suture material, which the body breaks down over time, avoiding the risk of stone formation. A key aspect of the repair is the two-layer closure technique, which provides added strength and integrity.
The first layer uses a continuous running suture to approximate the inner mucosa and submucosa, ensuring knots are not exposed to the urine stream. The second layer closes the outer detrusor muscle using an inverting suture pattern to reinforce the repair. Before completion, the surgical team performs a leak test using a sterile solution or colored dye to confirm a watertight seal.
A temporary urinary drainage system is necessary, allowing the suture line to heal without the stress of bladder filling. This is accomplished by placing a Foley catheter through the urethra to continuously drain urine. In some cases, a suprapubic catheter may be placed directly through the abdominal wall into the bladder.
Patient Recovery and Outlook
Following cystorrhaphy, recovery focuses on allowing the surgical repair to heal while managing urinary drainage. Patients typically expect a hospital stay of several days, depending on the surgery’s complexity and associated injuries. Pain management and early mobilization are encouraged to prevent complications and promote faster recovery.
The most significant aspect of post-operative care is managing the indwelling catheter, which diverts urine and maintains an empty, resting bladder. The catheter typically remains for 10 to 14 days, allowing the bladder wall layers to develop sufficient tensile strength. Before removal, a cystogram (an X-ray with contrast dye) is often performed to confirm complete healing and absence of leakage.
Patients are monitored for potential complications, including urinary tract infections, persistent leakage, or fistula formation (an abnormal connection between the bladder and another organ). The prognosis after successful cystorrhaphy is generally excellent, with most patients recovering normal bladder function. Patients are advised to limit strenuous activity and heavy lifting for several weeks to prevent undue pressure on the healing site.