O&G Cases · Gynaecological surgery — intraoperative complications and lower urinary tract injury
Ureteric and bladder injury recognised intraoperatively — emergency management station
Intraoperative emergency station: a ureteric injury (absent left jet) and an incidental bladder cystotomy recognised at cystoscopy during a difficult laparoscopic hysterectomy. Tests parallel recognition, level-specific ureteric reconstruction, two-layer bladder repair with thermal-margin debridement, closed-loop communication and honest disclosure. Includes assessor key and marking domains.
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Study tools
Target exams
Station brief
Format. Intraoperative emergency management station, approximately 12 minutes. You are the registrar in theatre. A scrub nurse and an anaesthetist are with you; the consultant is 15 minutes away and has been called, and a urologist is contactable. The assessor runs the clock and feeds you new findings. [1]
Candidate instruction. Lead the intraoperative management of a suspected left ureteric injury and an incidental bladder cystotomy. Verbalise your recognition steps, your repair decisions with named techniques, your escalation to urology, and your communication with the team, the consultant and (afterwards) the patient. [1][4]
References11ShowHide
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- [4]AAGL Advancing Minimally Invasive Gynecology Worldwide AAGL Practice Report: Practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy J Minim Invasive Gynecol, 2012.PMID 22748947
- [5]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 372: The Role of cystourethroscopy in the generalist obstetrician-gynecologist practice Obstet Gynecol, 2007.PMID 17601926
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- [14]McMillan E, Meepagala S, Ogbutor K, Monroe D, Gibbs T, Wheaton N, Ramkissoon NR, Zinabu SW, Michael MB Prevalence of Serotonergic Drug Use in Patients Exposed to Perioperative Methylene Blue: A Cross-Sectional Study Cureus, 2025.PMID 40271333
- [15]Scilipoti P, Nannola N, Zorzi F, Gonzalez CG, Chicaud M, Candela L, Moretto S, Nedbal C, Tefik T, Villa L, Ventimiglia E, Salonia A, Briganti A, Montorsi F, Somani BK, Doizi S, Traxer O, Panthier F Iatrogenic ureteric injuries after abdominal surgery: a systematic review and meta-regression from the European Association of Urology Endourology Section BJU Int, 2026.PMID 42023813
- [16]Sokol AI, Paraiso MF, Cogan SL, Bedaiwy MA, Escobar PF, Barber MD Prevention of vesicovaginal fistulas after laparoscopic hysterectomy with electrosurgical cystotomy in female mongrel dogs Am J Obstet Gynecol, 2004.PMID 15041991
- [17]Nezhat CH, Seidman DS, Nezhat F, Rottenberg H, Nezhat C Laparoscopic management of intentional and unintentional cystotomy J Urol, 1996.PMID 8808881