Bladder injuries during laparoscopic orchiopexy: incidence and lessons learned.
OBJECTIVE
Laparoscopic orchiopexy is a safe operation. However, the bladder can be injured during creation of the transperitoneal tunnel for the cryptorchid testis. We reviewed our experience with this complication.


METHODS
We searched the operative notes of patients who had undergone laparoscopic orchiopexy between August 15, 2002 and October 1, 2008, and identified bladder injuries and their treatment.


RESULTS
A total of 93 patients underwent laparoscopic orchiopexies for 101 undescended testes during the study interval, with 3 procedures resulting in bladder injuries. The 3 operations varied with regard to whether the injury was recognized intraoperatively or postoperatively, and repaired in an open or laparoscopic fashion.


CONCLUSIONS
Bladder injury during laparoscopic orchiopexy is a rare but serious complication that can be managed by an open or laparoscopic approach. We recommend placement of a urethral catheter and syringe assisted drainage of all urine from the bladder at the beginning of the operation, careful perivesical dissection particularly in children with prior inguinal surgery, filling and emptying of the bladder during the procedure, and maintaining a high index of suspicion especially when hematuria is observed.
Hsieh
Michael H
MH
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA. mhhsieh@stanfordalumni.org
Bayne
Aaron
A
Cisek
Lars J
LJ
Jones
Eric A
EA
Roth
David R
DR
D002675:Child, Preschool; D015331:Cohort Studies; D003456:Cryptorchidism / Q000000981:diagnostic imaging / Q000601:surgery*; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D020706:Laparoscopes / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011859:Radiography; D012042:Registries; D018570:Risk Assessment; D013737:Testis / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects* / Q000379:methods