Hysterectomy Causes Urinary Incontinence

This case involves a 44-year-old black female went to her Ob/Gyn for gynecological problems. The physician diagnosed severe fibroid growth and recommended a hysterectomy. The patient underwent a laparoscopic hysterectomy that was met with some complication. The patient experienced severe urinary retention and had to apply pressure over her suprapubic region in order to pass the urine. She had a few episodes of incontinence and experienced exquisite suprapubic pain during returning to the hospital. The patient underwent a diagnostic cystoscopy, cystogram and retrograde pyelogram and it was suspected that she sustained a right ureteral injury. After an unsuccessful attempt to place a nephrostomy tube, the decision was made to proceed with an exploratory laparotomy and repair of right ureteral injury due to fever, chills, right flank pain and increasing white blood count while on antibiotics. She was found to have a significant amount of urine in her abdomen (800 to 1000 ml). The conclusion was that the patient sustained a thermal injury to the right ureter with a very small millimeter pinpoint opening allowing extravasation of fluid.

Question(s) For Expert Witness

1. How common is it to have urinary issues after a hysterectomy?

Expert Witness Response E-006011

It is common to have some urinary retention after any abdominal surgery but prolonged urinary issues is suspicious for bladder or ureteral injury from surgery or underlying kidney damage. The surgeons technical skill may be called into question as the fibroid removal procedure may have been a bit too aggressive to the point where it may have affected the urinary system. If the fibroid growths invaded the urinary tract in any way, the Ob/Gyn surgeon may have benefited from calling in a surgical consult with a general surgeon or urologist.