Ureteral injury after vaginal hysterectomy...

by Heidi
(Francis Creek, WI)

On 5-18-11 I had a vaginal hysterectomy for uterine cysts and heavy menses. Three days post-op I developed vaginal urinary incontinence, was eventually diagnosed with severe damage to my right ureter which requires surgery in August.

The gynecologist told my mother following the surgery that there was "a lot of scar tissue on the posterior uterus." I am wondering, was the surgeon negligent by not performing an intra-operative cystoscopy to assess for bladder and/or uteral damage?

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ANSWER for "Ureteral injury after vaginal hysterectomy...":

Heidi:

Your question required a bit of research. Your surgeon’s decision not to perform intra-operative cystoscopy during your recent hysterectomy may have been a discretionary one and therefore would not be considered medical malpractice.

From the facts you present it appears the surgeon did find scar tissue on the posterior uterus. The question is was she then bound to perform an intra-operative cystoscopy.

The medical literature seems to indicate an intra-operative cystoscopy would have been appropriate when she located your uteral damage. However the literature does not indicate a decision not to do so would be medically dangerous.

In “The Use of Intraoperative Cystoscopy in Major Vaginal and Urogynecologic Surgeries” b y Kwon CH, Goldberg RP, and S. Koduri, the objective was to examine the frequency of significant intraoperative cystoscopic findings during major vaginal urogynecologic surgeries such as hysterectomies.

The issue of the importance of performing an intra-operative cystoscopy when uteral damage is found during a hysterectomy was discussed at length. The article concluded,

“The potential for damage to the lower urinary tract is significant with complex urogynecologic surgery. Because of the increased and delayed morbidity associated with unrecognized injury, intraoperative surveillance cystoscopy should be considered a part of all such procedures.”

Additional medical literature seems to come to somewhat similar conclusions. We suggest you also read, “The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy" by Sergio Ribeiro, Harry Reich, Jay Rosenberg, Enrica Guglielminetti, and Andrea Vidali.

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Best of luck,

Law Guy