UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Urinary tract injury in gynecologic surgery: Identification and management

Author
Donna Gilmour, MD, FRCSC
Section Editors
Linda Brubaker, MD, FACS, FACOG
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Urinary tract injury is known complication of gynecologic surgery. Intraoperative identification of injury permits prompt repair and potentially lessens postoperative sequelae including patient morbidity and cost. Delayed diagnosis of urinary tract injuries can result in complications beyond the site of the injury, such as genitourinary fistula formation or renal injury.

The evaluation and management of urinary tract injury in gynecologic surgery are reviewed here. Prevention of urinary tract injury and issues related to urinary tract injuries during advanced gynecologic surgery and obstetric procedures are reviewed separately.

(See "Urinary tract injury in gynecologic surgery: Prevention".)

(See "Surgical management of stress urinary incontinence in women: Retropubic midurethral slings", section on 'Urinary tract complications'.)

(See "Cesarean delivery: Technique", section on 'Bladder flap'.)

                            

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2016. | This topic last updated: Mar 4, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Teeluckdharry B, Gilmour D, Flowerdew G. Urinary Tract Injury at Benign Gynecologic Surgery and the Role of Cystoscopy: A Systematic Review and Meta-analysis. Obstet Gynecol 2015; 126:1161.
  2. American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Number 372. July 2007. The Role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol 2007; 110:221.
  3. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report: Practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy. J Minim Invasive Gynecol 2012; 19:407.
  4. Fischer JR. Just Do It!: Routine Cystoscopy Should Be Done at the Time of Gynecologic Surgery. Obstet Gynecol 2015; 126:1136.
  5. ACOG Committee on Practice Bulletins--Gynecology. ACOG Practice Bulletin No. 85: Pelvic organ prolapse. Obstet Gynecol 2007; 110:717.
  6. Ibeanu OA, Chesson RR, Echols KT, et al. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol 2009; 113:6.
  7. Kim JH, Moore C, Jones JS, et al. Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:531.
  8. Sakellariou P, Protopapas AG, Voulgaris Z, et al. Management of ureteric injuries during gynecological operations: 10 years experience. Eur J Obstet Gynecol Reprod Biol 2002; 101:179.
  9. Chi AM, Curran DS, Morgan DM, et al. Universal Cystoscopy After Benign Hysterectomy: Examining the Effects of an Institutional Policy. Obstet Gynecol 2016; 127:369.
  10. Vakili B, Chesson RR, Kyle BL, et al. The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy. Am J Obstet Gynecol 2005; 192:1599.
  11. Ferro A, Byck D, Gallup D. Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery. Am J Obstet Gynecol 2003; 189:354.
  12. Visco AG, Taber KH, Weidner AC, et al. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol 2001; 97:685.
  13. Buchsbaum GM, Moll C, Duecy EE. True occult bladder perforation during placement of tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct 2004; 15:432.
  14. Labin LC, Morse AN, Young SB. Vaginal revision of intravesical tension-free vaginal tape 44 h after initial placement: a case report. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:223.
  15. Doyle PJ, Lipetskaia L, Duecy E, et al. Sodium fluorescein use during intraoperative cystoscopy. Obstet Gynecol 2015; 125:548.
  16. Indigo carmine injection http://www.ashp.org/menu/DrugShortages/CurrentShortages/Bulletin.aspx?id=861 (Accessed on December 05, 2015).
  17. Graziano S, Hoyte L, Vilich F, Brubaker L. Life-threatening reaction to indigo carmine--a sulfa allergy? Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:418.
  18. Siff LN, Unger CA, Jelovsek JE, et al. Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates. Am J Obstet Gynecol 2016.
  19. Chan JK, Morrow J, Manetta A. Prevention of ureteral injuries in gynecologic surgery. Am J Obstet Gynecol 2003; 188:1273.
  20. Jelovsek JE, Chiung C, Chen G, et al. Incidence of lower urinary tract injury at the time of total laparoscopic hysterectomy. JSLS 2007; 11:422.
  21. Gilmour DT, Baskett TF. Disability and litigation from urinary tract injuries at benign gynecologic surgery in Canada. Obstet Gynecol 2005; 105:109.
  22. Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol 2006; 107:1366.
  23. Ramahi AJ, Richardson DA, Ataya KM. Urethral stones in women. A case report. J Reprod Med 1993; 38:743.
  24. Hove LD, Bock J, Christoffersen JK, Andreasson B. Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims. Acta Obstet Gynecol Scand 2010; 89:82.
  25. Sorinola O, Begum R. Prevention and management of ureteric injuries. Hosp Med 2005; 66:329.
  26. Stanhope CR, Wilson TO, Utz WJ, et al. Suture entrapment and secondary ureteral obstruction. Am J Obstet Gynecol 1991; 164:1513.
  27. Manahan KJ, Fanning J. Peritoneal fluid urea nitrogen and creatinine reference values. Obstet Gynecol 1999; 93:780.
  28. Nguyen-Khac E, Thevenot T, Capron D, et al. Are ascitic electrolytes usable in cirrhotic patients? Correlation of sodium, potassium, chloride, urea, and creatinine concentrations in ascitic fluid and blood. Eur J Intern Med 2008; 19:613.
  29. Wong MH, Lim SK, Ng KL, Ng KP. Pseudo-acute kidney injury with recurrent ascites due to intraperitoneal urine leakage. Intern Med J 2012; 42:848.
  30. Charalampidis S, Petrides C, Charalampous C, Stavrou S. Hyponatremic renal pseudofailure and massive ascites following normal vaginal delivery: a diagnostic and therapeutic challenge. Ren Fail 2012; 34:237.
  31. Kim JS, Lee DH, Suh HJ. Double-J stenting: initial management of injured ureters recognized late after gynecological surgery. Int Urogynecol J 2010; 21:699.
  32. Hastings JC, Van Winkle W, Barker E, et al. The effect of suture materials on healing wounds of the bladder. Surg Gynecol Obstet 1975; 140:933.
  33. Hanke PR, Timm P, Falk G, Kramer W. Behavior of different suture materials in the urinary bladder of the rabbit with special reference to wound healing, epithelization and crystallization. Urol Int 1994; 52:26.
  34. Hepperlen TW, Stinson W, Hutson J, Bartone FF. Epithelialization after cystotomy. Invest Urol 1975; 12:269.
  35. Bødker B, Lose G. Postoperative urinary retention in gynecologic patients. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:94.