Intraoperative complications of vaginal surgery

Approximately 70% of iatrogenic injuries to the genitourinary tract are not recognized at the time of operation (1). The long-term sequelae of these injuries include ureteral obstruction with loss of renal function and fistula formation. It is estimated that surgery for benign gynecologic conditions is responsible for 74% of genitourinary fistulas and over 90% of vesicovaginal fistulas in the United States (2). The vagina affords the urologist and urogynecologist an easily accessible, less morbid route for performing surgery to correct urinary incontinence and pelvic organ prolapse. But factors such as previous pelvic surgery, obesity, pelvic inflammatory disease, endometriosis, and pelvic irradiation can result in decreased organ mobility and impaired healing should an injury occur (3). The awareness of these risk factors for genitourinary injury, as well as the adoption of a few simple intraoperative precautions, can aid in their prevention and eventual recognition at the time of surgery. Early recognition of these injuries and proper postoperative management serve to decrease patient morbidity.