Iatrogenic ureteric injuries are a rare but serious complication of abdomino-pelvic surgery which can be associated with significant morbidity. 65-80% of ureteric trauma is only identified in the postoperative period. Current guidelines recommend stent insertion or urinary diversion via percutaneous nephrostomy. Good quality evidence on success and outcomes remains scant and the optimum treatment pathway unknown.A retrospective review of all delayed presentation ureteric injuries treated in our unit between 2005 and 2013 was performed. Clinical, treatment and outcome data were collected in a custom proforma.19 patients with 21 injured ureters met inclusion criteria. 16/19 (84.2%) injuries were sustained during gynaecological procedures with 10 (52.6%) of these during total abdominal hysterectomy. Suspected mechanisms from diagnostic studies was defined as partial transection in 9/21 (42.9%), complete transection in 3/21 (14.3%) and perforation in 1/21 (4.8%).Median time from injury to presentation was 16 days (IQR 7-25). 11/21 (52.4%) had successful stenting with a median time to stent placement of 25 days (IQR 18.5-42). Those with failed stenting had a median time to attempted stenting of 65 days (IQR 10-91.3). Those with successful stenting 3/11 (27.3%) had resolution requiring no further intervention. 6/11 (54.5%) required open reconstruction, with the remaining two patients unfit for reconstruction and managed with long term stents. With successful stenting median time to definitive surgery was 413 days (IQR 156-476).Success rates for stenting are similar to those reported in the literature (55% vs. 44-59%), but resolution rates are significantly lower (15% vs. 44-80%). Data for an endourological approach as a possible long-term solution is limited by heterogeneity, and a further well conducted multicentre prospective study is required.

To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject.A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma.Findings of 350 citations are reviewed.The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior.

Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon's skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.

The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury.

Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery.Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95% confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery.Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2% of patients in the single-incision group and in 0.7% of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95% confidence interval 1.00-5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I2 = 0%) and no evidence of publication bias.Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.