ABSTRACT
Given their anatomical proximity to gastrointestinal and reproductive organs, urological structures are innately prone to iatrogenic injury during obstetric and gynecological procedures. Among a large series of iatrogenic ureteral injuries, gynecological surgery has been identified as the primary operation associated with injury in 73% of the cases. Rates of genitourinary injuries for specific gynecological surgeries vary greatly, especially among contemporary series, due in large part to the impact of the introduction of laparoscopic and robotic approaches. Carley et al. reported rates of 0.35% to 5.13% for genitourinary injury during gynecological procedures. However, three large population studies, either retrospective or prospective in nature, found rates of only 0.3% to 0.8% in more contemporary settings. The improvement is most likely due to a number of factors, including modifications in surgical techniques, greater experience and training with minimally invasive techniques, use of adjunctive tools for identification of injury, and a greater emphasis on early recognition and prevention. In addition, there has been greater emphasis on identifying putative risk factors for injury and possible preventative measures to avoid injury. This chapter focuses on two main subjects: ureteric injuries and use of urinary diversion.
