Urological complications following gynaecological surgery

Iatrogenic injury of the lower urinary tract occurs during benign gynaecological surgery with a frequency of approximately 0.3%. The injuries sustained are often not detected intra-operatively, but on many occasions, the vulnerability of the urinary tract to injury can be anticipated by rigorous pre-operative assessment and the risk of injury reduced by intra-operative vigilance. Primary prevention offers the best outcome for patients, reducing acute and long-term morbidity, and reducing the risk of litigation. A high index of suspicion must be maintained for patients who present with atypical symptoms such as loin pain or per vaginal clear fluid loss following gynaecological surgery and early recourse to imaging and urological review should be sought. The risk of litigation following iatrogenic urinary tract damage can be reduced by appropriate behaviour of clinicians. Iatrogenic urinary tract infection or bladder over-distension injuries can also be reduced by following evidence based guidelines for cystoscopy and catheterization.