Hysterectomy

Question 1

Suspect ureter ligation when? (This also presents with same symptoms)

Tx?

Answer 1

Pyelonephritis symptoms (Fever, flank tenderness) after surgery (Thermal injury to ureter)

Antibiotics and relief of obstruction

Question 2

Cardinal ligament attaches? Contains?

Answer 2

Uterine cervix to pelvic sidewalls; uterine arteries

Question 3

Intravenous pyelogram used to examine?

Answer 3

Kidneys, ureters, bladder

Question 4

Cystoscopy?

Answer 4

Scope placed into the bladder via the urethra

Question 5

Percutaneous nephrostomy?

Answer 5

Used to relieve urinary obstruction by placing a stent into renal pelvis

Question 6

Most common location for ureteral injury?

Answer 6

Cardinal ligament – ureter is 2-3 cm lateral to cervix

Question 7

Ureteral injuries at the pelvic brim occur doing what surgeries?

Where the ureter enters the bladder?

Answer 7

Ligation of the ovarian vessels (infundibular pelvic ligament)

When the vaginal cuff is ligated at the end of the hysterectomy

Question 8

Outside of surgery, other risk factors for ureteral injury?

Answer 8

Adhesions
cancer
endometriosis
tubo-ovarian abscess
residual ovaries
interligamentous Leiomyoma

Question 9

Suspect bladder perforation when patient develops what symptoms?

Answer 9

Gross hematuria, pain, tenderness in the suprapubic region and difficulty voiding

Question 10

Over dissection of the ureter may lead to?

Answer 10

Devascularization injury (ischemic injury)

Question 11

Patient diagnosed with you ureteral ligation susceptible to?

Answer 11

Hydronephrosis or hydroureter

Question 12

Management of bladder lacerations?

Answer 12

Dome (top) – can be situated at time of surgery

Trigone (lower) may need ureter stent placement to prevent stricture