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Procedures Causing GU Injury

The reconstructive urologist and urogynecologist rarely see the operation that caused the injury they are asked to repair. Obstetric and gynecologic operations can injure the bladder and can be followed by vesicovaginal or vesicouterine fistula.[4][5] Gynecologic, colorectal, general, and vascular pelvic operations can injure the ureter and lead to stricture.[3]

This section describes the non-urologic operations most likely to produce injuries that reach the reconstructive surgeon.

Articles​

  • Cesarean SectionHow cesarean delivery can injure the bladder and ureter, and the anatomy behind those injuries.
  • HysterectomyBladder and ureteral injury across abdominal, vaginal, laparoscopic and robotic hysterectomy, and the delayed fistula that follows a missed one.
  • Radical Hysterectomy and Pelvic LymphadenectomyHow radicality and nerve preservation trade off against ureteral injury and bladder dysfunction.
  • Pelvic Tumor ResectionUreteral and bladder injury and reconstruction during sarcoma, ovarian cytoreduction and extended or recurrent pelvic resection.

Planned additions​

  • Colpopexy & prolapse repair. Ureteral injury during uterosacral ligament suspension (Shull, Mayo-McCall); bladder injury during anterior repair and mesh placement.
  • Anti-incontinence surgery. Bladder perforation during retropubic and transobturator sling placement; urethral erosion; outlet obstruction.
  • Colorectal surgery (LAR, APR, total mesorectal excision). Ureteral injury at the pelvic brim and in the deep pelvis; case reports describe rectourethral fistula after LAR[1] and urethrocutaneous fistula after APR.[2]
  • Inguinal & pelvic hernia repair. Bladder injury during trocar or balloon access in laparoscopic extraperitoneal inguinal repair[6]; delayed mesh and tack erosion into the bladder after laparoscopic repair[7]; vasal injury during open inguinal repair.
  • Pelvic trauma & pelvic ring fixation. Bladder rupture and posterior urethral disruption from pelvic fracture; delayed pubic-symphysis screw migration into the bladder after fixation has been described[8]; sciatic nerve injury from posterior ring hardware.

References​

1. Mouawad C, El Helou E, Dahboul H, et al. "Laparoscopic repair of acquired rectourethral fistula by vesical peritoneal flap." Asian J Endosc Surg. 2023;16(4):814-818. doi:10.1111/ases.13230

2. Yassein A, Dason S, Davies T, Kelly S. "A novel approach to the repair of urethrocutaneous fistulae arising after abdominoperineal anorectal resection." Can Urol Assoc J. 2015;9(11-12):E879-E881. doi:10.5489/cuaj.2938

3. Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FKH, Fisch M. "Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies." Asian J Urol. 2018;5(2):101-106. doi:10.1016/j.ajur.2018.02.003

4. Jensen AS, Heinemeier IIK, Schroll JB, Rudnicki M. "Iatrogenic bladder injury following gynecologic and obstetric surgery: A systematic review and meta-analysis." Acta Obstet Gynecol Scand. 2023;102(12):1608-1617. doi:10.1111/aogs.14641

5. Bonavina G, Busnelli A, Acerboni S, Martini A, Candiani M, Bulfoni A. "Surgical repair of post-cesarean vesicouterine fistula: A systematic review and a plea for prevention." Int J Gynaecol Obstet. 2024;165(3):894-915. doi:10.1002/ijgo.15256

6. Dalessandri KM, Bhoyrul S, Mulvihill SJ. "Laparoscopic hernia repair and bladder injury." JSLS. 2001;5(2):175-177. PMID:11394432

7. Liu WZ, Qian JH, Shen ZJ, Yang BB, Cheng Y. "Fixing tacks induced bladder erosion and recurrent stones following laparoscopic inguinal hernia repair: a case report." BMC Surg. 2020;20(1):161. doi:10.1186/s12893-020-00818-4

8. Ulrich CR, Ndeh BA, Fitzwater RH, Sop JL, Duvall NM, Sop AL. "Delayed migration of orthopedic screw into the bladder following pelvic fracture fixation." Trauma Case Rep. 2026;61:101298. doi:10.1016/j.tcr.2026.101298