Urinary tract injury in pelvic surgery

All pelvic operations have the potential to create a urinary tract injury. These injuries can often be prevented by thoughtful preoperative planning, familiarity with the anatomic relations involved, careful sharp dissection technique, use of traction and countertraction, and maintenance of meticulous hemostasis. If injury does occur, intraoperative detection, whether through direct inspection or through the use of a cystoscopic technique, helps ensure a good outcome. When the injury is discovered while the patient is still under anesthesia, correction of the problem can be accomplished with little inconvenience to the patient and, most often, with no long-term sequelae. During the postoperative period a high index of suspicion must be maintained, with an immediate evaluation instituted for any patient in whom a urinary tract injury is suspected.