The urethra, bladder, and ureters are particularly susceptible to injury during gynecologic surgery. When preventive measures fail, prompt recognition and management of injury can avoid long-term sequelae such as fistula formation and loss of renal function. Intraoperative identification should be the primary goal when an injury occurs, although this is not always possible. Postoperative injury recognition requires a high level of suspicion and vigilance. In addition to history and physical examination, appropriate radiologic studies can be useful in localizing injury and planning management strategies. Some injuries may require Foley catheter drainage or ureteral stenting alone, whereas others will require operative intervention with ureteral resection and reanastomosis or reimplantation. Prompt restoration of urinary drainage or diversion will avoid further renal compromise.
Prevention, prompt recognition, and management of urologic injuries after gynecologic surgery will reduce the risks of fistula formation and loss of renal function.
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
Corresponding author: Howard T. Sharp, MD, 30 North 1900 East, Suite 2B200, Salt Lake City, UT 84132; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.
Continuing medical education for this article is available at http://links.lww.com/AOG/A799.