This might give you a leg up--take a look at the MESH headings, too.


Lee Hover, D. Med. Hum.
Lacey, WA.

1. Urologia. 2013 Apr 24;80 Suppl 22:24-7. doi: 10.5301/RU.2013.10619. Epub
2013 Jan

[Management of iatrogenic gynecologic injuries with urologic relevance.
and prevention of complications: the gynecologist's opinion].

[Article in Italian]

Jasonni VM(1), Matonti G.

Author information: 
(1)Toniolo Clinic, Gynepro Medical, Italy. [log in to unmask]

Comment in
    Urologia. 2014 Jul-Sep;81(3):187-8.

OBJECTIVE: To detect and prevent urinary tract injuries in gynecological
METHODS: A brief review of the literature about recognition and prevention
ureteral and bladder injuries.
RESULTS: It is well known that factors as intra-operative bleeding, pelvic
adhesions and infections, pelvic masses, endometriosis and obesity can make
surgery difficult. For these reasons the study of the urinary tract and the
of ureteral catheters may be helpful when alterations of the urinary tract
anatomy is suspected. However the surgeon should always operate under direct
vision of the ureters with a judicious use of diathermy and taking care when
separating bladder from the uterus where the blunt dissection is blind and
dangerous. When there are some doubts about the integrity of ureters, the
with i.v. infusion of indigo-carmine or with ureteral catheters should be
performed. The same applies for the bladder: the cystoscopy should be in the
armamentarium of gynecological surgeons to control the ureteral efflux and
bladder integrity. To fill the bladder with methylene blue at the end of the
surgery is also helpful in revealing, under the pressure, even very small
as well as partial thickness of the bladder that can cause a delayed
CONCLUSIONS: Surgeons' training is the most important factor in avoiding and
detecting urinary tract injuries. This is important not only for the
but also in the selection of patients, and then in planning the more
pre-operative study and in recognizing the presence of injuries during

DOI: 10.5301/RU.2013.10619 
PMID: 23341201  [PubMed - indexed for MEDLINE]

-----Original Message-----
From: Medical Libraries Discussion List [mailto:[log in to unmask]] On
Behalf Of Truex, Eleanor
Sent: Monday, November 14, 2016 7:13 AM
To: [log in to unmask]
Subject: Help, please, with a difficult search in obstetric surgery

I have been really struggling over this one all last week. Here it is:
In case of suspected BLADDER injury (described to me as a "nick") during a
C-secxn, the established procedure is as follows: carmine indigo* or
methylene blue is injected into the bladder via the Foley (urinary catheter)
that all C-secxn patients have. If there is a nick in the bladder or
anywhere else in the urinary tract, the blue will show in the pelvic cavity,
whereupon the surgeon can repair the injury prior to closing (after the baby
has been removed, of course). That is the common procedure. The Clin Ed RN
for OB here is looking for EBP aka a rationale for using methylene blue
(which has been identified in other uses as not so great).

I cannot find any. I broadened the search to hysterectomy/other pelvic
surgery because C-secxn wasn't providing any real results. I have found out
about other VERY dubious practices, such as flushing the bladder with
"sterile" baby formula (formula is not sterile to OR standards and should
never be used as a flush).

I have found many articles relating injuries to the ureters and how to
repair them, but really nothing on the method used to assess the injuries in
the first place. I have looked into actual surgical procedure textbooks,
PubMed/Medline, EDS. I am by no means confident about my PubMed searching
being comprehensive, so if anyone has any tips, please share them here or in
private email. This search involves OB, Urology and Surgery-always hard when
things cross specialities.

Can anyone help? Thanks so much.

*carmine indigo has become insanely expensive.

Eleanor Truex BSN, MLIS
Medical Librarian, Lakeshore Region

Saint Francis Hospital
355 Ridge Avenue | Evanston, IL 60202
Office: 847.316.2460

Saint Joseph Hospital
2900 North Lake Shore Drive | Chicago, IL 06057
Office: 773.665.3038

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