Urinary injuries

Question 1

Rate of ureteric injuries?

Answer 1

Benign surgery: 0.4-2.5%
Abdo hyst: 0.1-1.7%
Vag hyst: 0-0.1%
Laparoscopic: 1.6%
Uterosacral ligament suspension: 11%
Rad hyst: 30%

Question 2

What % of urinary injuries are identified intraop?

Answer 2

30%

Question 3

What surgical approach has highest ureteric injury rate?

Answer 3

Laparoscopy

Question 4

What intraop test can identify ureteric injury

Answer 4

Cystoscopy with indigo carmine IV

Question 5

How to manage a crush injury of the ureter?

Answer 5

Stent for 6-12 weeks, intrabdominal drain

Question 6

How to manage a complete or partial transection?

Answer 6

Above the pelvic brim: repair with endo-to-end anastomosis (uretero-ureterostomy)
Within 4-6 cm of UV junction: reimplantation (ureteroneocystotomy)

Question 7

Rate of bladder injury?

Answer 7

0.5-1%

Question 8

Most common location of ureteric injury in TAH?

Answer 8

IP ligament, paracervical, tunnel of werthiem

Question 9

Most common location of ureteric injury in vag hyst?

Answer 9

Ureteric entry into trigone

Question 10

Most common location of ureteric injury in laparoscopy?

Answer 10

Ablation of endometriosis at uterosacral ligament

Question 11

What are the types of ureteric injury?

Answer 11

Needle perforation
Crush
Ligation/transection
Angulation or kinking
Ischemic
Thermal

Question 12

Principles of fistula repair

Answer 12

tension free
no infection or inflammation
multiple layers
hemostasis

Question 13

When to excise fistulous tract?

Answer 13

If vesicovaginal, no need to excise it

If rectovaginal, must excise it

Question 14

How to differentiate between a VV and a UV fistula?

Answer 14

Put a tampon in.
Take pyridium PO and instill MB into bladder. Wait
Take tampon out. If orange, it is UV. If blue, it is VV