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Urinary Tract Injury at the Time of Laparoscopic and Robotic Surgery: Presentation and Management

Evans, Janelle Morgan MD*†; Karram, Mickey M. MD*†; Mahdy, Ayman MD, PhD; Robertshaw, Daniel MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2013 - Volume 19 - Issue 4 - p 249–252
doi: 10.1097/SPV.0b013e318294600a
Case Reports

Objective To report a series of urinary tract injuries resultant of laparoscopic or robotic procedures performed for a gynecologic indication.

Methods We identified 16 patients with urinary tract fistulas after laparoscopic or robotic gynecologic procedures between 2009 and 2012. We extracted demographic data and prior surgical data as well as reviewed our management of each case.

Results Thirteen subjects had undergone robotic procedures, 2 traditional laparoscopies, and a single-port laparoscopy with time to presentation from 2 days to 9 months postoperatively. Seven patients presented with vesicovaginal fistulas (43%), of which one healed spontaneously. Eight patients had ureterovaginal fistulas. Two patients (25%) were managed with ureteroneocystotomy, 2 patients (25%) were managed with Boari flap, and 4 patients (50%) were managed with double-J stent placement. One patient had a vesicocervical fistula managed via trachelectomy and partial cystectomy.

Conclusion The authors have seen an increase in referrals for urinary tract fistulas in minimally invasive surgery. It is imperative to investigate the effect of a steep learning curve, unfamiliarity with new energy sources, or poor patient selection as contributing factors.

Trends of increasing urinary tract injuries may be noted with minimally invasive surgery.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, The Christ Hospital, Cincinnati, OH; and †Department of Urology, The University of Cincinnati, Cincinnati, OH.

Reprints: Janelle Morgan Evans, MD, The Christ Hospital and University of Cincinnati, 2123 Auburn Ave, Suite 307, Cincinnati, OH 45219. E-mail: or

Dr. Karram is a speaker for American Medical Systems, Medtronic, and Astellas Pharmaceuticals. The remaining authors have declared they have no conflicts of interest.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.