Injuries to the Bladder

Iatrogenic injuries to the bladder can occur as a result of any pelvic surgery, most often during vaginal or abdominal hysterectomy, colorectal oncologic resections, and endoscopic resections of bladder tumors. In a large review of the complications of laparoscopic procedures, the incidence of bladder injuries ranged from 0.02% to 8.3%.10 This was usually the result of ill-advised placement of a trocar in addition to dissection injuries. Injury is more likely if the bladder is left full during trocar placement. Meanwhile, having the bladder slightly full can sometimes facilitate dissection of the tissue planes surrounding it during pelvic dissection.

Figure 13-4.1. Boari flap. (Reprinted with the permission of The Cleveland Clinic Foundation.]

quently used procedure in any other situation. The only absolute contraindication to TUU is either a ureter of insufficient length to reach the contralateral side or a diseased recipient ureter. Repair of a ureteral injury secondary to aortic aneurysm surgery in this manner would not be recommended because of the fibrosis likely to be encountered. A TUU may, however, be the only viable option in a patient with significant pathology precluding dissection and exposure deeper in the pelvis.

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