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A hysterectomy is sometimes done as a way to treat uterine cancer, heavy uterine bleeding or other uterine problem. It is done sometimes as a laparoscopic procedure, an open procedure or a vaginal procedure and sometimes the ovaries and fallopian tube are taken at the same time. The biggest problem with the hysterectomy and the bladder is that the bladder sits on the anterior aspect of the uterus and they are in close contact with one another. It is all too easy for a careless surgeon to accidentally cut into the bladder or damage the ureters on either side of the bladder. If you think that your injury was caused as a result of medical negligence, contact our hysterectomy injury solicitors for advice at no cost.

In one study of eight hundred thirty nine patients, there was urinary tract injury associated with the finding of hysterectomy in 4.3 percent of cases (39 cases). Bladder injury occurred in 2.9 percent of cases and ureteral injury occurred in 1.8 percent of cases (15 cases). Three cases occurred in which both the bladder and ureters were involved. The injuries were detected using diagnostic cystoscopy in most cases. Eighty percent of the injuries to the ureter occurred where the ureter met the bladder. The most common type of injury was transaction or kinking of the ureter. The most common injury to the bladder was puncture of the bladder.

Puncture of the bladder during hysterectomy is a complication that can lead to urine leaking into the abdominal and pelvic cavity. There can be a permanent fixture formed in the area which can mean that the bladder leaks into the vagina or other tissues. If it leaks into the vagina, there can be constant vaginal leakage of urine out from the body. This often requires cutting out the fistula and correcting the defect in the vagina and in the urine. Fistulae are often infected with a small amount of bacteria making them difficult to simply close as they are. The infected part must be completely removed before the defect is more easily closed. If a puncture or cut occurs into the bladder or ureters at the time of surgery and is detected right away, the incision can be closed completely with suture material and it is most likely completely curable at the time of the injury.

The risk of having a ureteral or bladder injury at the time of the hysterectomy is infection in the bladder from bacteria coming up from the vagina. If the vagina is not affected, there will not likely be an infection and there will simply be the passage of sterile urine into the pelvic space. If an infection occurs, it tends to be chronic and unrelenting as there is little way to clear up the infection as long as the defect remains.

The treatment of urinary tract injury after hysterectomy varies with the degree of injury and with the location of the injury. There can be surgical repair of the injury if it has not been a long time since the injury recurred. If there is a fistula or chronic hole in the urinary tract, the individual may need to be treated with a urinary catheter, which decreases the pressure in the bladder and allows for healing of the injury over time. It can take up to three to six months of having a urinary catheter placed in order to have healing of the injury to the bladder or ureter. Kinking of the ureter can be corrected surgically with little long term damage to the ureter.

If you have ureteral or bladder damage secondary to a hysterectomy, you may not notice it right away. You may notice pain in the flank if there is ureteral kinking and back up of urine into the ureter. You may notice a decrease in urinary output with more urine going into the pelvic space than in the urethra. Speak to the surgeon about these things and have a cystogram done to see if the ureters or bladder has been damaged.

Medical Negligence Solicitors

Our hysterectomy injury solicitors operate the no win no fee scheme which is totally without risk. You only pay legal charges if the case is won. There are no upfront charges to pay whatsoever. If you would like to discuss your potential compensation claim with a specialist medical negligence solicitor just complete the contact form or email our solicitors offices or use the helpline. Once you have provided sufficient information you will speak with a hysterectomy injury solicitor who will advise you on the prospects of success for your claim and an estimated amount of compensation that may be awarded. Our advice is totally without cost and there is no further obligation to use our legal services. Do yourself justice and give us a call.

Hysterectomy Injury - UTI Overview

The incidence of urinary tract injury during hysterectomy is about 4.3 percent for all types of hysterectomy. The rate of bladder injury was 2.9 percent and the rate of ureteral injury is 1.8 percent. Transection and kinking injuries are the most common types of injuries. The kinking injuries were exclusive to the ureters, which kinked during the operative procedure but most of the time were successfully unkinked on their own without intervention. The level of injury to the ureters was primarily at the level of the uterine artery. This occurred in 80 percent of injuries to the ureter.

In other cases, the ureters are accidentally transected. In one study, the transection also occurred at the level of the uterine artery—the artery that needs to be ligated at the time of the hysterectomy. Ureteral injuries can result in blockage of the ureter, which leads to back up of urine in the kidneys. Eventually, the increased pressure in the kidneys will unkink the ureter and the injury will resolve itself. If the ureter is instead transected, the urine may leak out of the ureters into the abdominal cavity and may not be discovered for a period of time.

Injury to the bladder is the most common injury to the urinary tract in cases of hysterectomy. In most cases, a puncture wound or slice is made into the urinary bladder and the bladder begins to leak into the pelvic space. This may not be noted right away but eventually, there may be a vesico-vaginal fistula, which is an inflammatory fistula that constantly drains urine into the vagina, leading to chronic drainage and incontinence of urine. It can be big enough that there may be no voiding of the urinary bladder whatsoever and only drainage of the urine through the vagina occurs. This can fortunately be repaired surgically in many cases so the bladder functions normally again. Sometimes a woman needs to have a catheter placed in the urinary bladder for several weeks time to allow for healing of smaller vesico-vaginal fistulas.

Urethral injuries are non-existent in abdominal hysterectomies but do happen on rare occasions in the vaginal hysterectomy. The urethra can be crushed with instrumentation and can take some time to decompress. Transections of the short female urethra are extremely rare and would be truly accidental.

One way doctors go about assuring themselves that there is no bladder or ureteral injury is to perform a post procedure cystoscopy. A cystoscopy will look directly at the bladder and will be able to tell if there is any injury to the bladder. In addition, dye can be passed up the ureters to make sure the ureter is patent and is not kinked at all. Dye can be inserted into the bladder and the doctor can look for passage of dye into the vagina in cases of suspected vesico-vaginal fistulas. If the dye is seen in the vagina, then a fistula exists that must be addressed by the surgeon.

Fortunately, injuries to the bladder, ureters and urethra are not common and most women have their hysterectomy without complication. This is true of both abdominal hysterectomy and vaginal hysterectomy. If an injury to the bladder or ureters does occur, the surgeon can either repair the injury or allow it to heal secondarily.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here