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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. Bladder injuries, ureteral injuries, vesicovaginal and vesicouterine fistulas, and ureteral strictures most often originate in operations performed by other specialists — obstetricians, gynecologic oncologists, colorectal surgeons, general surgeons, vascular surgeons. To repair these injuries well, we must understand the operations that produce them: where the dissection planes travel, what structures sit where, and which steps place the urinary tract at risk.

This section is a surgical operator's reference to the non-urologic operations most likely to produce injuries that enter the reconstructive surgeon's practice. Each article treats the operation from the reconstructive urologist's perspective — enough anatomy and technique to understand the mechanism of injury, enough complication data to anticipate what walks into clinic.

Articles​

  • Cesarean SectionJoel-Cohen vs Pfannenstiel entry, bladder flap dissection, hysterotomy, uterine closure — anatomic origins of bladder injury, ureteral injury, vesicouterine fistula (Youssef syndrome), and uterine niche / isthmocele.

Planned additions​

  • Hysterectomy (abdominal, laparoscopic, robotic, vaginal) — ureteral injury at the infundibulopelvic ligament, cardinal ligament, and uterine artery crossing; bladder injury during anterior colpotomy; vesicovaginal fistula pathogenesis.
  • Radical hysterectomy & pelvic lymphadenectomy — ureteral injury in the paravesical and pararectal spaces; nerve-sparing planes.
  • 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; rectourethral fistula after APR.
  • Inguinal & pelvic hernia repair — bladder injury during laparoscopic mesh placement; vasal injury during open inguinal repair.
  • Pelvic trauma & pelvic ring fixation — bladder rupture; posterior urethral disruption; sciatic nerve injury from posterior ring hardware.