Transvaginal repair of bladder lacerations during LAVH

Eight bladder lacerations occurred during laparoscopic-assisted vaginal hysterectomy (LAVH) at a university-affiliated private hospital. All were exposed vaginally. Six were repaired with a standard two-layer closure by the vaginal route. One patient had a combined vaginal and laparoscopic repair. Another had a partial ureteric avulsion that was repaired vaginally, and a double-J ureteric catheter was left in situ for 6 weeks. All patients underwent cystoscopy to confirm adequate closure and confirmation of ureteric patency. All repairs were successful. The planned procedure (LAVH) was completed without further complications and the hospital stay was not prolonged as a result of the injury. The patient with partial ureteric avulsion had a normal intravenous pyelogram, and the ureteric catheter was removed in the office by transurethral cystoscopy. We conclude that bladder injuries during LAVH can be readily identified intraoperatively. Excellent results can be achieved with transvaginal repair, and the planned procedure can be completed by the intended route. Cystoscopy to confirm ureteric patency is essential after all repairs.