Recognition and management of iatrogenic injury to the genitourinary system

Abstract

Iatrogenic injury of the genitourinary system is a rare but potentially devastating complication of pelvic surgery. Many of these injuries can be prevented with appropriate steps. First, preoperative imaging should be obtained to evaluate for anatomical distortion due to mass effect, involvement of genitourinary structures by pelvic pathology, and congenital abnormalities such as duplicated ureters. Second, the operating surgeon should have a complete understanding of pelvic anatomy and the ability to recognize and isolate genitourinary structures during the operation. As a general principle, the operating surgeon should have a low threshold to formally evaluate for genitourinary system injury with cystoscopy, retrograde filling of the bladder, retrograde pyelograms, and various imaging modalities. A urologist should be consulted if an injury to the genitourinary system is identified or if there is sufficient concern for an unidentified injury. The immediate recognition and repair of an injury provides patients with the best outcomes.