The pelvic surgeon is obligated to prevent operative injuries to the urinary tract, to recognize an injury if and when it occurs, and to salvage the functional integrity of the urinary tract as expeditiously and accurately as humanly possible. One cannot perform pelvic surgery without realizing the intimacy of the relationships of all of the pelvic structures–anatomically, functionally, physiologically, pathologically, and hormonally. Therefore, the gynecologic surgeon must at all times be “urinary tract conscious” and, for that matter, aware of the relationships of the lower gastrointestinal tract, great vessels, and nerves.Our chief fears must be (1) crippling the patient, either temporarily or permanently, (2) compromising the final result by inappropriate, ill-advised treatment, and (3) the ever increasing likelihood of a malpractice suit. However, we must not let hesitancy, indecisiveness, and fear of criticism overwhelm the confidence, boldness, and innovative thinking that we acquire increasingly through training and experience.
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