| September 2005 · Vol. 17, No. 9 SURGICAL TECHNIQUE
CONTROVERSIES IN PELVIC SURGERY
Avoiding lower urinary tract injury
Urogynecologists discuss the rising injury rate, the reasons behind it, and techniques for safe and successful pelvic surgery.
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Fast Track
Most injuries occur during straightforward hysterectomies—Geoffrey Cundiff, MD
If the lower urinary tract is evaluated only when injury is suspected, a good number of injuries will be missed—Geoffrey Cundiff, MD
After abdominal surgery, assess the urinary tract via suprapubic telescopy or high extraperitoneal cystotomy—Mickey Karram, MD
Very little or no education is provided in preventing lower urinary tract injury—Alfred Bent, MD
Routinely mobilize the bladder flap using sharp dissection—never blunt dissection—Alfred Bent, MD
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OUR EXPERT PANELISTS
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Moderator Mickey Karram, MD, Director of Urogynecology, Good Samaritan Hospital, Cincinnati, and Professor of Obstetrics and Gynecology, University of Cincinnati.
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Matthew Barber, MD, MHS, Section of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics & Gynecology and Urology, Cleveland Clinic, Cleveland.
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Alfred Bent, MD, Head, Division of Gynecology, Department of Obstetrics and Gynecology, Dalhousie University, IWK Health Center, Halifax, Nova Scotia.
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Geoffrey Cundiff, MD, Professor of Obstetrics and Gynecology, Johns Hopkins University, Baltimore.
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Unfortunate but true: Many complications of pelvic surgery involve injury to the lower urinary tract—and many of these injuries go undetected and increase the patient’s risk of serious morbidity and the physician’s chances of being sued.
Even more unfortunate: These injuries are on the rise, thanks to the proliferation of anti-incontinence surgeries, greater use of laparoscopy, and the need for increasingly complex vaginal dissection.
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