The surgical management of stress urinary incontinence with or without combined prolapse treatment continues to evolve. New technologies have emerged which have impacted surgical treatment algorithms. Cystoscopy has been added as a standard component of the procedure during surgical implantation of slings.

Iatrogenic injury to the urinary tract during colorectal surgery can be a source of significant morbidity. Although most cases of ureteral injury occur in patients without significant risk factors, the incidence of urinary tract injuries increases in patients with prior pelvic operations, inflammatory bowel disease, infection, and in patients with extensive neoplasms causing distortion of normal surgical planes. The most commonly injured locations are the ureter, bladder, and urethra. Mechanisms of injury include ligation, transection, devascularization, and energy induced. Early identification of urinary tract injuries is paramount in minimizing morbidity and preservation of renal function. Anatomic considerations for preventing injuries, diagnostic techniques for localizing and staging injuries, as well as reconstructive techniques and principles of repair are discussed. KEYWORDS: Iatrogenic injury, repair, ureter, bladder, urethraObjectives: Upon completion of this article, the reader should have an understanding of the location of iatrogenic injuries to the urinary tract, anatomic considerations for preventing injuries, diagnostic techniques for localizing and staging injuries, as well as reconstructive techniques for repair.Iatrogenic injury to the urinary tract during operations within the pelvis and retroperitoneum occur most commonly to the ureters followed by injuries to the bladder and urethra. Although most cases of ureteral injury occur in patients without significant risk factors, 1 the incidence of urinary tract injuries increases in patients with prior pelvic operations, inflammatory bowel disease, infection, and in patients with extensive neoplasms causing distortion of normal surgical planes. Unrecognized congenital anomalies such as a duplicated ureter (1/125 persons), retrocaval ureter, horseshoe or pelvic kidneys (1/400 persons) can present unfamiliar anatomy to the surgeon.2 In some cases, resection and reconstruction of a portion of the urinary tract is mandated by disease severity. The rate of urologic complications with the application of minimally invasive technologies (laparoscopy and robotics) for colorectal procedures has been relatively constant when compared with open surgical techniques. Use of the various energy-based tissue devices in close proximity to the urinary tract can cause a delayed presentation of a urinary injury. Early identification of urinary tract injuries is paramount in minimizing morbidity and preservation of renal function. Intraoperative repair of injuries to the urinary tract can be performed through consultation with a urologic surgeon or by the initial operating surgeon. Principles of repair for specific injuries are discussed herein.

The Panel recognizes that each patient presenting with LUTS is unique. This Guideline is intended to serve as a tool facilitating the most effective utilization of urodynamic testing as part of a comprehensive evaluation of patients presenting with LUTS.

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Transurethral collagen injection therapy is a reasonable treatment option for post-prostatectomy incontinence in select patients in whom more conservative therapy has failed. However, patients who have required a penile clamp, experienced continuous leakage or undergone transurethral incision of a bladder neck contracture are unlikely to respond well to this treatment.