Urological surgical techniques

Urinary tract injuries during gynaecological surgery are increasing with the advent of more complex and laparoscopic techniques; ureteric and bladder injuries are the most common. Adequate knowledge of the anatomy will help avoid some problems, but prompt recognition during surgery offers the best chance of treatment without long-term compromise. When the problems are not recognised during surgery, various techniques can be used to effect repair. Surgery for stress incontinence has undergone many changes in technique in recent years. Any procedure needs to combine a low morbidity with high long-term success rates. Colposuspension has been the ‘gold standard' for many years, against which other techniques are judged. A laparoscopic approach has reduced hospital stay, although with increased morbidity. The tension-free vaginal tape technique is now widely employed as the first-line procedure. It is a relatively easy technique to learn, with a good success rate and low morbidity; long-term results are still awaited. This chapter deals with two aspects of urogynaecological surgery. The first section reviews urinary tract injuries occurring during gynaecological surgery. In the second section we look at recent developments in surgery for urinary stress incontinence.