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Lower Urinary Tract
Injuries During
Gynecologic Surgery
Chapter 37
Vincent Lucente, MD, MBA and
Cristina M. Saiz, MD, FACOG❍ What is the overall incidence of urologic injury during gynecologic procedures?
Injury to the lower urinary tract (LUT) occurs during 1% to 2% of all major gynecologic procedures. Given the
absence of routine cystoscopy during benign gynecologic procedures, the overall incidence of lower urinary tract
injuries (LUTI) is most likely underestimated.
❍ What urologic organ is most commonly injured?
Bladder injuries outnumber ureteral injuries, with a ratio of 5.3:1. A recent review (Gilmour, 2006) that included
47 studies and over 120,000 patients estimated the incidence of bladder and ureteral injury to be 2.6/1000 and
1.6/1000, respectively.
❍ What is the best way to prevent injuries to the LUT during surgery?
The most successful prevention method, as well as cost-effective, is the surgeon’s profound knowledge of pelvic
anatomy and the use of proper surgical dissection techniques.
❍ Is preoperative ureteral stent placement a good method to prevent LUT injuries?
The usefulness of preoperative lighted ureteral stent placement has been questioned in that it does not secure
avoidance of the injury and it is not a cost-effective measure.
❍ What is the most important step to avoid long-term sequelae after LUT injuries?
Intraoperative detection and immediate repair is the single most important step in decreasing long-term
complications such as fistula formation. Several studies have demonstrated the usefulness of routine cystoscopy
in order to detect unsuspected LUTI during benign gynecologic surgery, although a recent study evaluating the
routine use of cystoscopy after hysterectomy supported its selective rather than universal use.