1. Urological injuries in OBG Practice
DR.H.K.NAGARAJ
M.B.B.S., M.S., M.Ch., F.I.C.S.,
Sr.Prof & Head,
Urology Unit-1
M.S.Ramaiah Medical College And Hospital
Bangalore-54.

7. Causes of injuries Hysterectomy open / Laparascopy – Bladder/ureteric
Caesarian section
C. Surgery for endometriosis/PID/Malignancy
D. Obstructed Labour-Bladder and urethra
E. Anterior Colporraphy
F. Sling Surgery

8. Urological injuries Bladder injury leading to V.V.F.
Ureteric injuries unilateral leading to ureterovaginal fistula or ureteric stricture
Bilateral ureteral injury leading to uremia/urinary ascites

9. Symptoms/Presentation
Silent
Haematuria
Urine leak per vagina - immediate / delayed
Fever
Sepsis
Flank pain
Vomiting
Urinary ascites, Ileus

10. Intraoperative detection
Excessive watery ooze
Routine indigo carmine test
Methylene blue
Role of intra op cystoscopy.

11. Indigo-Carmine Test

12. Immediate post-op detection
Urine leak per vagina
Urine leak in the wound
Leukocytosis, azotemia, acidosis
Creatinine levels of the drain fluid

13. Delayed detection Hydroureteronephrosis Nonfunctioning kidney
Urinary fistulae

14. Investigations Ultrasound scan of abdomen I.V.U. X ray
CT with contrast
Antegrade Nephrostogram
Retrograde Ureterogram
MCU
Cystoscopy & methylene blue test

15. USG showing hydroureteronephrosis secondary to ureteric stricture

16. CT urogram

17. Retrograde ureterogram

18. Antegrade Nephrostogram

19. MCU

20. Cystoscopy

21. Management D.J.Stenting End to end anastomosis Ureteric reimplantation
Psoas hitch/boari flap
Ileal ureter
V.V.F. Repair

22. D J Stenting

23. End to End anastomosis

24. Ureteric Reimplantation

25. Psoas hitch

26. Boari flap Tongue shaped flap from the Urinary Bladder
Ureter is anastomosed to the tubularised bladder flap over a DJ stent

28. V.V.F. repair

29. Early laparoscopic repair for supratrigonal vesicovaginal fistula International Gynaecology Journal July 2007, Volume 18, Issue 7, pp
HK Nagaraj , TA Kishore et al
Laparoscopic repair undertaken 2-4 wks after initial surgery. – Excellent outcomes

30. A Simplified Laparoscopic Approach to Repair Vesicovaginal Fistula: The M.S. Ramaiah Technique Tarun Dilip Javali, Amit Katti, and Harohalli K. Nagaraj UROLOGY 85: 544e546, 2015

31. Prevention Exposure to urinary tract Ureteric catheter insertion
Use weck clips
Stay close to uterus
Prevent lateral tear of uterus during caesarian
Put a drain-when in doubt
Keep partially full bladder
Use large size catheters to drain bladder
Do bed side U/s abd

33. Thank you