Repair of Multiple Complicated Genitourinary Tract Injuries following Emergent C-Hysterectomy

Peripartum hysterectomy poses a significant risk of urinary tract injury, with potential resultant negative sequelae in the long term. In this study, our aim is to present a surgical video that showcases the repair of multiple complicated genitourinary tract injuries following a cesarean hysterectomy. Additionally, we aim to offer valuable insights on preoperative workup, surgical techniques, and postoperative recovery, thereby enhancing clinical knowledge and improving patient outcomes.

Methods
This video was performed using a retrospective review of the case to analyze medical records and surgical videos of a patient who underwent repair of genitourinary tract injuries following peripartum hysterectomy. Data on preoperative workup, surgical techniques, and postoperative outcomes was collected. The video complies with ethical guidelines and an IRB waiver was obtained at our institution. The video editing of this 6 hour long surgery was done using Final Cut Pro (Apple, Cupertino CA).

Clinical Relevance:
This video showcasing the repair of multiple complicated genitourinary tract injuries following peripartum hysterectomy has significant clinical relevance for our sub-specialty. By visually depicting the surgical techniques, the video can provide valuable insights and tips for preoperative workup, surgical planning, and postoperative recovery. Moreover, the video can help surgeons identify the complexities involved in the repair of such injuries, thereby enhancing their clinical knowledge and improving patient outcomes.
The learning points highlighted in the video have important takeaways. Early identification of genitourinary injuries is crucial to optimize surgical planning and minimize adverse outcomes. Preoperative evaluation, including specific imaging studies, can provide critical information for surgical planning. Timing of repair is dictated by the overall clinical picture, and a collaborative approach involving multiple specialties can help ensure optimal outcomes. The video also highlights the potential for anterograde ureteral stents by interventional radiology, intra-vesical botox injections to overcome loss of bladder capacity, and the importance of planning for open surgery while considering starting with a minimally invasive approaches. Overall, the video showcasing the repairs has significant clinical relevance for urogynecologists and urologists. The insights and tips provided in the video can help enhance clinical and surgical knowledge in this area.