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The main purpose of this study was to report the incidence of lower urinary tract injuries (UTI) during cesarean section (CS) hysterectomy in cases of Placenta Accreta Spectrum (PAS) disorders. Study design Retrospective analysis including all women with a prenatal diagnosis of PAS between January 2010 and December 2020. A dedicated multidisciplinary team was involved to define a tailored management for each patient. All relevant demographic parameters, risk factors, degree of placental adhesion, type of surgery, complications and operative outcomes were reported. One hundred and fifty-six singleton gestations with a prenatal diagnosis PAS were included in the analysis. 32.7% of cases were classified as PAS 1 (grade 1-3a FIGO classification), 20.5% as PAS 2 (grade 3b FIGO classification) and 46.8% as PAS 3 (grade 3c FIGO classification). A CS hysterectomy was performed in all cases. Surgical complication occurred in seventeen cases (0% in PAS 1, 12.5% in PAS 2 cases and in 17.8% in PAS 3). The incidence of UTI in our series was 7.6% in all women with PAS, including 8 cases of bladder and 12 of ureteral lesion, and 13.7 % in those with PAS 3 only. Despite advances in prenatal diagnosis and management, surgical complications, mainly those involving the urinary system, still occur in a significant proportion of women undergoing surgery for PAS. The findings from this study highlight the need for a multidisciplinary management of women with PAS in centers with high expertise in prenatal diagnosis and surgical management of these conditions. [ABSTRACT FROM AUTHOR]

Key message: Ureteral injuries are often associated with complications and risk of fistula especially in case of malignancy. Length of catheterization should be reconsidered according to the injury. Purpose: Iatrogenic urinary tract injuries are potential complications of gynecologic and obstetric surgery. Our aim was to describe suture type and size, length of urethral catheterization, length of hospitalization, reoperation rate, follow-up, and impact on quality of life following iatrogenic bladder and ureteral injury. Methods: In total, 81 women met inclusion criteria. Bladder injuries included 55 women, ureteral injuries in 23 women, and three women had bladder and ureteral injuries. Results: Most bladder injuries were managed by a two-layer suture followed by transurethral catheterization for 11.4 days (95% CI 9.1–13.6). The most frequent suture type was 3.0 Vicryl in all subgroups. In total, 30.4% of ureteral injuries were managed by neoimplantation followed by ureteral stenting for 38.0 days (95% CI 22.0–54.0) and transurethral catheterization for 16.9 days (95% CI 5.3–28.4), or by ureteral stenting for 46.7 days (95% CI 31.5–61.2) and transurethral catheterization for 6.25 days (95% CI 1.0–13.5). Altogether, 25 (30.9%) women underwent a reoperation mostly due to ureteral injury (68%). In total six women developed a fistula, of whom five had malignant surgery. Multiple linear regression showed a statistically significant increased median length of urethral catheterization when the duration of surgery increased. Conclusions: Our study demonstrates a high reoperation rate, and a high fistula rate in case of malignancy. Length of catheterization was high even in case of benign surgery, however, only one woman developed a fistula in the benign group, suggesting a reduction in catheterization length. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery.Methods: A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury.Results: In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations.Conclusion: Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations. [ABSTRACT FROM AUTHOR]

Urinary tract injury during cesarean delivery is a rare but severe complication. Due to the high prevalence of cesarean delivery, this injury may pose a high burden of morbidity. We reviewed the cases of lower urinary tract injuries identified during cesarean delivery in a tertiary medical center and identified diagnosis and treatment methods, as well as short and long-term outcomes, to establish a protocol of care for such cases. We included women with urinary tract injury during cesarean delivery between 2004 and 2018. The cases were identified according to ICD-9 codes, as well as free text in the medical report and discharge letter. Data were collected retrospectively. Telephone interviews were conducted to obtain additional data regarding long-term outcomes. In14 years, a total of 17,794 cesarean deliveries were performed at our institution (17.5% of all deliveries), 14 cases of bladder injury, and 11 cases of ureteral injury were identified featuring an incidence of 0.08 and 0.06%, respectively. All bladder injuries were diagnosed and repaired intra-operatively. Six (55%) cases of ureteral injury were diagnosed in the post-operative period, and 3 of these patients required further surgery for definitive treatment. None of the patients suffered long-term adverse effects. Most bladder injuries occurred in women with previous cesarean delivery in the presence of abdominal adhesions. In contrast, most ureteral injuries occurred in women with emergency cesarean delivery during the second stage of labor, and were accompanied by an extension of the uterine incision. All women had normal kidney function in follow up and did not suffer from long term sequelae. Urinary tract injury is an uncommon complication of cesarean delivery. A high index of suspicion is recommended to avoid late diagnosis and complications. We propose a comprehensive protocol for the management of these injuries. [ABSTRACT FROM AUTHOR]

A man in his 70s suffered cardiac arrest, and his family initiated cardiopulmonary resuscitation after placing an emergency call. The initial waveform of the automated external defibrillator performed by emergency medical technicians revealed ventricular fibrillation. The patient received cardiovascular life support, including direct current countershock, and was transported to the hospital. Upon arrival, he underwent extracorporeal cardiopulmonary resuscitation using an automated chest compression device. Additionally, an intra-aortic balloon pumping was introduced after coronary angiography and percutaneous coronary intervention. Plain computed tomography images revealed leakage of the contrast medium used during coronary angiography in the bilateral renal pelvis and perirenal area as well as bladder retention. Furthermore, a urine test revealed gross hematuria. There were no findings of prostatic hypertrophy or urinary tract disease. Based on the patient's clinical course, injury caused by chest compression was the most likely etiology of urinary tract injury, which must be considered in such patients. The patient was discharged with cerebral performance category 1, without any complication except urinary tract., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tada et al.)

Background: To assess the feasibility of use of indocyanine green (ICG) in identifying and minimising urinary tract injury during surgical resection of endometriosis through robotic transvaginal natural orifice transluminal endoscopy surgery (RvNOTES)., Methods: We conducted a retrospective case series in two academic tertiary care hospitals. We examined 53 patients who underwent RvNOTES hysterectomy with planned endometriosis resection., Results: The study involved 53 patients undergoing RvNOTES with ICG fluorescence for endometriosis resection. Mean patient age was 37.98 ± 6.65 years. Operative time averaged 181.32 ± 53.94 min, with estimated blood loss at 45.57 ± 33.62 mL. Postoperative stay averaged 0.23 ± 0.47 days. No ICG-related complications occurred., Conclusion: No complications occurred with ICG fluorescence in RvNOTES. It appears to be a safe option for ureteral localisation and preservation. ICG fluorescence is widely used in diverse medical specialities for identifying ureters during complex surgeries. Larger studies are needed to firmly establish its advantages in intraoperative ureteral visualisation during RvNOTES for deep infiltrative endometriosis., (© 2024 John Wiley & Sons Ltd.)

Study Objective: Compare odds of postoperative urinary symptoms in women who had cystoscopy after benign laparoscopic hysterectomy with 50% dextrose and with normal saline solution with intravenous indigo carmine.Design: Retrospective cohort study.Setting: Two tertiary care centers.Patients: All women who underwent benign laparoscopic hysterectomy and intraoperative cystoscopy carried out by a single surgeon.Interventions: We compared postoperative urinary symptoms in patients who received 50% dextrose cystoscopy fluid (January 2016-June 2017) with those who received saline cystoscopy with intravenous indigo carmine (November 2013-April 2014).Measurements and Main Results: A total of 96 patients had cystoscopy with 50% dextrose and 104 with normal saline with intravenous indigo carmine. Differences in baseline characteristics of the two groups of participants mainly reflected institutional population diversity: age (45.2 vs 41.9, p = .01), body mass index (26.9 vs 33.4, p <.01), race, current smoking status (1% vs 7.8%, p = .04), diabetes (2.1% vs 11.5%, p = .01), history of abdominal surgery (53.1% vs 74%, p <.01), hysterectomy type, receipt of intraoperative antibiotics (92.7% vs 100%, p <.01), recatheterization (10.4% vs 0%, p <.01), and removal of catheter on postoperative day 0 (66.7% vs 12.5%, p <.01). Urinary symptoms were similar for 50% dextrose and saline (12.5% vs 7.7%, p = .19). After adjusting for age, body mass index, race, diabetes, and day of catheter removal, there remained no significant differences in urinary symptoms between the groups (odds ratio 3.19 [95% confidence interval, 0.82-12.35], p = .09). One immediate bladder injury was detected in the saline group and 1 delayed lower urinary tract injury in the 50% dextrose group.Conclusion: Overall, most women experienced no urinary symptoms after benign laparoscopic hysterectomy. There were no significant differences in postoperative urinary symptoms or empiric treatment of urinary tract infection after the use of 50% dextrose cystoscopy fluid as compared with normal saline. The previous finding of increased odds of urinary tract infection after dextrose cystoscopy may be due to use in a high-risk population. [ABSTRACT FROM AUTHOR]

To determine the prevalence and types of iatrogenic urinary tract injuries during obstetrics and gynaecological procedures and to find out the possible risk factors. Methods: In this cross sectional study all patients undergoing major obstetrics and gynaecological surgeries were included. Variables included the personal data, age of the patient at time of surgery, Indication , type of surgery , location and type of injury and possible risk factors. Surgical approach and cause of injury was determined. Data regarding risk factors was collected on specified proforma. Iatrogenic urinary tract injury was defined as any inadvertent injury to the urinary tract for which additional intervention and observation was required. Major surgery was any surgery with duration more than 30 minutes including opening of peritoneal cavity. Results: Records of 1800 patients was studied. Out of 1900 patients 8(0.44 %) suffered from iatrogenic urinary tract injuries. Median age of patients was 33 years. The procedure in which most urinary tract injuries occurred was peripartum hysterectomy, second most common procedure was total abdominal hysterectomy. Most common injury was injury to urinary bladder. It was injured in 5 (0.27 %) cases.Ureters were damaged in 2 (0.11%) patients. Urethra was damaged during.1( 0.05%) procedure. The main risk factor was previous surgery with resultant adhesions present in 75% of patients having iatrogenic urinary tract injuries. Seven cases of injury were diagnosed at the time of operation and successfully repaired. 0ne case was diagnosed late and developed ureterovaginal fistula. Conclusion: Iatrogenic urinary tract injury is uncommon but carries serious morbidity. Adhesions due to previous surgery were an important risk factor

Background: To determine the prevalence and types of iatrogenic urinary tract injuries during obstetrics and gynaecological procedures and to find out the possible risk factors. Methods: In this cross sectional study all patients undergoing major obstetrics and gynaecological surgeries were included. Variables included the personal data, age of the patient at time of surgery, Indication, type of surgery, location and type of injury and possible risk factors. Surgical approach and cause of injury was determined. Data regarding risk factors was collected on specified proforma. Iatrogenic urinary tract injury was defined as any inadvertent injury to the urinary tract for which additional intervention and observation was required. Major surgery was any surgery with duration more than 30 minutes including opening of peritoneal cavity. Results: Records of 1800 patients was studied. Out of 1900 patients 8(0.44 %) suffered from iatrogenic urinary tract injuries. Median age of patients was 33 years. The procedure in which most urinary tract injuries occurred was peripartum hysterectomy, second most common procedure was total abdominal hysterectomy. Most common injury was injury to urinary bladder. It was injured in 5 (0.27 %) cases. Ureters were damaged in 2 (0.11%) patients. Urethra was damaged during.1(0.05%) procedure. The main risk factor was previous surgery with resultant adhesions present in 75% of patients having iatrogenic urinary tract injuries. Seven cases of injury were diagnosed at the time of operation and successfully repaired. 0ne case was diagnosed late and developed ureterovaginal fistula. Conclusion: Iatrogenic urinary tract injury is uncommon but carries serious morbidity. Adhesions due to previous surgery were an important risk factor. [ABSTRACT FROM AUTHOR]

Background: To determine the frequency of urinary tract injury during Obstetrics and Gynaecological surgery in the tertiary care teaching set up. Methods: In this descriptive study, all the patients who were admitted for obstetrical and gynaecological surgery irrespective of the time of procedure and level of surgical expertise were evaluated. Forty seven patients with bladder injury and six patients with ureteric injury were included. Site of injury, type and nature of surgical procedure, and therapeutic success rate with respect to time of diagnosis and treatment was analyzed. Injury was defined as entry into the urinary tract lumen, crushing, ligation or/and excision of urinary tract, leakage of urine, post operative hydronephrosis, or extravasation of contrast outside the urinary tract with or without renal damage that required surgical intervention. Results: The injury incidence in obstetrics emergency and elective procedures was 0.69% with urinary bladder the most frequently injured organ (88.67%). No ureteric injury was recorded in obstetrical patients. In gynaecological patients ratio of injuries to bladder and ureter was 4.84%. Most of the ureteric injuries (50%) were encountered in emergency laparotomy, followed by malignant ovarian tumours (33.3%). Most of the injuries were picked and dealt during the same surgical session with 15% of the patients requiring reoperation. Outcome of the management was satisfactory with no renal damage and mortality. Conclusion: Good knowledge of pelvic anatomy and practicing the visualization of ureteric course in routine patients will be helpful to safeguard it during complicated cases.

Background: Ureteral injury is a known complication of hysterectomies. Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies. Some studies have reported that as surgeon volume increases, urinary tract injury rates decrease. To our knowledge, no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy., Aim: To determine the incidence of urinary tract injury between urogynecologists, gynecologic oncologists, and general gynecologists., Methods: The study took place from January 1, 2016 to December 1, 2021 at a large community hospital in Detroit, Michigan. We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon's volume per year was calculated. Patient demographics, medical history, physician-dictated operative reports, and all hospital visits postoperatively were reviewed., Results: Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group excluding urinary tract, bowel, or major vessel injury. High-volume surgeons had four (1%) patients with a complication and low-volume surgeons had 12 (4%) patients with a complication ( P = 0.04)., Conclusion: Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists, however our study was underpowered., Competing Interests: Conflict-of-interest statement: We have no conflicts of interest to disclose and there has been no financial support for this research that could have influenced the outcome. As the corresponding author, I confirm that the manuscript has been reviewed and approved for submission by all authors., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Gynaecology surgery is the commonest cause of iatrogenic injury of the urinary tract. Rapidly evolving surgical techniques and gynaecological training involving less surgical experience compared to previous years means there is a need to proactively minimise this risk. If ureteric injury is unrecognised it can result in prolonged morbidity and potential loss of organ function. Injuries may be avoidable by preoperative assessment, attention to risk factors and meticulous surgical technique. Counselling patients regarding potential injury is important especially if there are pre-existing risk factors. A high index of suspicion and prompt evaluation may improve immediate recognition and thereby improve prognosis. Any delay in postoperative recovery especially with flank pain should raise the suspicion of urinary tract injury and prompt diagnostic evaluation should be undertaken. Surgical repair should be done by specialists with sufficient expertise and woman should be debriefed and followed up to improve patient satisfaction and reduce litigation rates. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease.Methods: Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines).Results: Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B).Conclusion: The application of these recommendations should minimize risks associated with hysterectomy. [ABSTRACT FROM AUTHOR]

Injuries to the urinary tract during laparoscopic hysterectomy are quite rare, but are among the most serious injuries that occur during gynecologic surgery. Injury rates among subtypes of laparoscopic hysterectomy have been found to be similar. The most effective way to avoid urinary tract injury is knowledge of urinary tract anatomy and careful and thoughtful dissection. [ABSTRACT FROM AUTHOR]

Study Objectives: To evaluate the incidence, detection, characteristics, and management of urinary tract injury in a cohort undergoing laparoscopic hysterectomy, and to identify potential risk factors for urinary tract injury with laparoscopic hysterectomy.Design: Retrospective analysis (Canadian Task Force classification II-2).Setting: Kaiser Permanente San Diego Medical Center, 2001 to 2012.Patients: Women who underwent attempted laparoscopic hysterectomy for benign indications.Interventions: Total laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and laparoscopic supracervical hysterectomy.Measurements and Main Results: Demographic and clinical characteristics, surgical techniques, and perioperative complications were abstracted from the medical record. Multivariable logistic regression analysis assessed independent risk factors for ureteral or bladder injury.Results: A total of 3523 patients (mean age, 45.9 ± 8.0 years; median parity, 2; range, 0-10), with a median body mass index (BMI) of 29 kg/m(2) (range, 16-72 kg/m(2)), underwent laparoscopic hysterectomy; 20% had intraoperative cystoscopy. The incidence of urinary tract injury was 1.3% (46 of 3523); of the 46 patients with injuries, 19 (0.54%) had ureteral injuries, 25 (0.71%) had bladder injuries, and 2 (0.06%) had both types. Of the 21 ureteral injuries, 6 (29%) were diagnosed intraoperatively and 15 (71%) were diagnosed postoperatively, including 4 with normal intraoperative cystoscopy. Of the 27 bladder injuries, 23 (85%) were identified intraoperatively. In multivariable logistic analysis, a BMI of 26 to 30 kg/m(2) (compared with >30 kg/m(2)) was associated with an increased risk of ureteral injury, and a BMI ≤25 kg/m(2) (compared with >30 kg/m(2)) and the presence of endometriosis were associated with an increased risk of bladder injury.Conclusion: Urinary tract injury occurred in 1.3% of laparoscopic hysterectomies, with ureteral injuries almost as common as bladder injuries. Normal intraoperative cystoscopy findings did not exclude the presence of ureteral injury. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Today laparoscopic hysterectomy (LH) can be performed safely and effectively, even for women with a previous history of cesarean section (CS). However, it is unclear whether the risk of urinary tract injury increases with previous CS during LH. Methods: PubMed and Embase databases were searched for all studies on previous history of CS and risk of urinary tract injuries during and after LH. Reference lists of the identified studies, reviews, and other relevant publications were also searched. Urinary tract injuries or related complications were the outcomes of interest. Meta-analysis was conducted using an inverse-variance weighted random-effects model. Results: A total of 7 studies including 3,191 patients were identified in the meta-analysis. Overall, the pooled relative risk (RR) and the corresponding 95 % confidence interval (CI) of urinary tract injury were 3.48 (1.86-6.50) for previous CS compared with no previous CS. However, only two studies reported sufficient data on ureteral injury, and the combined RR was 1.83 (95 % CI 0.19-17.26). All seven studies reported the outcomes of bladder injury, and the pooled RR was 3.75 (95 % CI 1.96-7.17). Stratified analyses showed a basically consistent result with the overall analysis except for that by 1-2 times of previous CS (RR 2.32, 95 % CI 0.56-9.56). Conclusions: Previous CS is significantly associated with development of bladder injury during LH. No significant association was found yet between previous CS and risk of ureteral injury. Given the limited number of studies, more future studies are required to confirm the associations. [ABSTRACT FROM AUTHOR]

Background: To determine the frequency of urinary tract injury during Obstetrics and Gynaecological surgery in the tertiary care teaching set up. Methods: In this descriptive study, all the patients who were admitted for obstetrical and gynaecological surgery irrespective of the time of procedure and level of surgical expertise were evaluated. Forty seven patients with bladder injury and six patients with ureteric injury were included. Site of injury, type and nature of surgical procedure, and therapeutic success rate with respect to time of diagnosis and treatment was analyzed. Injury was defined as entry into the urinary tract lumen, crushing, ligation or/and excision of urinary tract, leakage of urine, post operative hydronephrosis, or extravasation of contrast outside the urinary tract with or without renal damage that required surgical intervention. Results: The injury incidence in obstetrics emergency and elective procedures was 0.69% with urinary bladder the most frequently injured organ (88.67%). No ureteric injury was recorded in obstetrical patients. In gynaecological patients ratio of injuries to bladder and ureter was 4.84%. Most of the ureteric injuries (50%) were encountered in emergency laparotomy, followed by malignant ovarian tumours (33.3%). Most of the injuries were picked and dealt during the same surgical session with 15% of the patients requiring reoperation. Outcome of the management was satisfactory with no renal damage and mortality. Conclusion: Good knowledge of pelvic anatomy and practicing the visualization of ureteric course in routine patients will be helpful to safeguard it during complicated cases. [ABSTRACT FROM AUTHOR]

Abstract: Background: Few studies have examined the current status of ureteral stent use or the indications for stenting, particularly in laparoscopic colorectal surgery. This study examines current national trends and predictors of ureteral stenting in patients undergoing major colorectal operations and the subsequent effects on perioperative outcomes. Methods: The 2005–2011 National Surgical Quality Improvement participant user files were used to identify patients undergoing laparoscopic segmental colectomy, low anterior resection, or proctectomy. Trends in stent use were assessed across procedure types. To estimate the predictors of stent utilization, a forward-stepwise logistic regression model was used. A 3:1 nearest neighbor propensity match with subsequent multivariable adjustment was then used to estimate the impact of stents. Results: A total of 42,311 cases were identified, of which 1795 (4.2%) underwent ureteral stent placement. Predictors of stent utilization included diverticular disease, need for radical resection (versus segmental colectomy), recent radiotherapy, and more recent calendar year. After adjustment, ureteral stenting appeared to be associated with a small increase in median operative time (44 min) and a trivial increase in length of stay (5.4%, P < 0.001). However, there were no significant differences in morbidity or mortality. Conclusions: We describe the clinical predictors of ureteral stent usage in this patient population and report that while stenting adds to operative time, it is not associated with significantly increased morbidity or mortality after adjusting for diagnosis and comorbidities. Focused institutional studies are necessary in the future to address the utility of ureteral stents in the identification and possible prevention of iatrogenic injury. [Copyright &y& Elsevier]

Abstract: Gynaecology surgery is the commonest cause of iatrogenic injury of the urinary tract. There is a need to minimize this risk with rapidly evolving surgical techniques and gynaecological training involving lesser surgical experience compared to previous years. Ureteric injury can often be unrecognized and results in prolonged morbidity and potential loss of organ function. Risk factors exist in most cases and injuries may be avoidable by preoperative assessment and meticulous surgical technique. Counselling patients regarding potential injury is important especially if there are pre- existing risk factors. A high index of suspicion and prompt evaluation may improve immediate recognition and thereby improve prognosis. Any delay in postoperative recovery especially with flank pain should raise the suspicion of urinary tract injury and prompt diagnostic evaluation should be undertaken. Surgical repair should be done by specialists with sufficient expertize and woman should be debriefed and followed up to improve patient satisfaction and reduce litigation rates. [Copyright &y& Elsevier]