ORIGINAL ARTICLE Maternal lower urinary tract injury at the time of Cesarean delivery Sallie S. Oliphant & Katarzyna Bochenska & Madeline E. Tolge & Janet M. Catov & Halina M. Zyczynski Received: 14 March 2014 /Accepted: 26 May 2014 /Published online: 26 June 2014 # The International Urogynecological Association 2014 Abstract Introduction and hypothesis To determine the incidence of lower urinary tract (LUT) injury at the time of Cesarean delivery (CD) and to identify factors associated with LUT injury. Methods Cases of LUT injury at delivery between 2001 and 2012, were identified by ICD-9 code. Chart review was utilized for verification and descriptive data collec- tion. LUT injury incidence rates were calculated using annual delivery totals and trends over time were calculat- ed using simple linear regression. LUT injury was classi- fied as full-thickness bladder injury (including ureteral injury) or partial-thickness bladder injury based on degree of injury and post-operative intervention. Each case was year-matched to generate two CD controls. Logistic regression analysis was performed using maternal, deliv- ery, and health system characteristics to identify factors associated with full or partial injury. Appropriate statisti- cal analyses were performed with significance at p <0.05. Results Overall delivery and CD rates increased during the study time period, but despite the increase in CD rates, annual rates of LUT injury did not vary significantly (p =0.658). Of the 72 LUT injuries reported, 39 (54 %) were full-thickness bladder, 2 (3 %) ureteral, and 31 (43 %) were partial-thickness bladder injuries. Full injury, controlling for repeat CD, was associated with increasing maternal age, transfusion, and ac- tive second stage of labor. Partial injury, was associated with increasing maternal age and delivery in the first half of the academic year. Conclusions Despite an increasing volume of CDs, LUT injury remained relatively uncommon (0.3 % of all CDs). Full and partial bladder injuries have unique risk profiles. Keywords Cesarean delivery . Cystotomy . Lower urinary tract injury Introduction Lower urinary tract (LUT) injury at Cesarean delivery (CD) is an established surgical complication, which may result in significant patient morbidity. Over the past 30 years, the incidence of CD has increased dramatically. A published analysis of National Hospital Discharge Survey data showed that age-adjusted rates of CD in the United States doubled between 1979 and 2006 [1]. Contemporary reports have also shown a continued trend with an increasing CD rate between 1999 and 2010 [2, 3], although in the last 2 years rates have declined slightly [2]. Furthermore, retrospective US-based studies have shown that the incidence of LUT injury during CD ranges from 0.28 to 0.43 % [4, 5]. Similarly, international Presented at the 39th Scientific Meeting of the Society of Gynecologic Surgeons, Charleston, SC, 8–10 April 2013 S. S. Oliphant : K. Bochenska : H. M. Zyczynski (*) Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA e-mail: hzyczynski@mail.magee.edu M. E. Tolge Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA J. M. Catov Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA Present Address: S. S. Oliphant Division of Urogynecology, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA Int Urogynecol J (2014) 25:1709–1714 DOI 10.1007/s00192-014-2446-2