GENITOURINARY COMPLICATIONS IN ORTHOPAEDIC SURGERY

Schematic view of the anterior approach to the lumbar spine, highlighting its relevant genitourinary and neurovascular anatomy. Anatomy labeled as follows: a) presacral plexus, b) posterior peritoneum (cut away), c) psoas major, d) ureter, e) inguinal ligament, f) sigmoid colon, g) bladder, h) sigmoid arteries, i) common iliac artery, j) common iliac vein

Genitourinary complications following orthopaedic intervention are uncommon but well-described occurrences and exist on a spectrum of severity. These complications vary depending on the anatomic location and surgical approach, with surgery of the spine, hip, and pelvis of particular concern. Injuries to the urinary tract may present acutely with urinary retention or hematuria. However, they often have a delayed presentation with severe complications such as urinary fistula and recurrent infection. Delayed presentations may place the onus of timely and proper diagnosis on the orthopaedic provider, who may serve as the patient’s primary source of long-term follow-up. Detailed knowledge of anatomy and at-risk structures is key to both preventing and identifying injury. Although iatrogenic injury is not always avoidable, early identification can help to facilitate timely evaluation and management to prevent long-term complications such as bladder dysfunction, obstructive renal injury, sexual dysfunction, and chronic pain. 

Schematic view of the retroperitoneal approach to the lumbar spine at the level of the L4 vertebral body, highlighting its relevant genitourinary and neurovascular anatomy; a) colon, b) peritoneum, c) ureter (d + e) genitofemoral nerve, f) sympathetic trunk, g) aorta, h) inferior vena cava

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Genitourinary complications in orthopaedic surgery | SpringerLink

Published November 11, 2022 in the European Journal of Orthopaedic Surgery & Traumatology.