“I Was Leaking From the Wrong Place”: Bladder and Ureter Injuries During Surgery
Summary
The bladder and the ureters (the tubes carrying urine from the kidneys) sit close to the uterus, bowel and other pelvic organs, so they can be injured during a hysterectomy, caesarean or other pelvic operation. Most bladder injuries are found and repaired straight away. Ureter injuries are often found later. This guide is for people whose injury was missed or whose symptoms were dismissed. It explains the risks, warning signs, what should happen, and when it may be negligence.
Quick answer · updated November 2026
A systematic review found most bladder injuries are recognised during surgery, but most ureter injuries are found afterwards, typically 10 to 14 days later. Fever, flank pain, a swollen tummy, leaking urine from the vagina or very little urine after pelvic surgery should be checked promptly. If your injury was missed, you can ask for your records and get advice.
Urinary tract injury at a glance
- 1Before surgeryYou should be told about the risk to bladder and ureters.
- 2During surgeryInjuries recognised in theatre can usually be repaired then.
- 3The days afterWatch for fever, flank pain or leaking.
- 4If it is missedInvestigation with scans should not be delayed.
- 5RepairA urologist may need to repair or reimplant the ureter.
At any stage: fever, severe flank or tummy pain, or very little urine after surgery needs same-day review.
I had a laparoscopic hysterectomy for heavy bleeding at forty-six. The surgeon said I’d be home in a day or two and back at work in six weeks.
I went home on day two. By day five I had a fever and a dull pain in my right side, under my ribs. My tummy was swollen. The ward said it was normal post-op discomfort and wind.
On day nine, I noticed a constant trickle of clear fluid from my vagina. I thought it was discharge. Then I realised it was urine, and I wasn’t controlling it.
I was so embarrassed I nearly didn’t ring anyone.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you were injured during pelvic surgery, and especially if your symptoms were dismissed afterwards, I want you to know that your questions are reasonable. These injuries are frightening, embarrassing and exhausting. Asking why it took so long to find is not making a fuss.
This guide covers how the bladder and ureters can be injured, why some injuries are found late, the warning signs, what should happen, what your records should show, and how the law looks at it.
Why I can write this
I have been a medical negligence lawyer since 2014 and have worked on many hundreds of claims, including many involving gynaecological and obstetric surgery. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts in this article are checked against named sources, listed in the references, and I explain how I work in our editorial standards.
Start with your question
- How are the bladder and ureters injured in surgery?
- How common are bladder injuries in hysterectomy?
- Why are ureter injuries found late?
- What are the signs of a bladder or ureter injury?
- What is a fistula?
- How are these injuries repaired?
- Could a missed injury be negligence?
How injuries happen
The bladder sits in front of the uterus, and each ureter runs down the side of the pelvis, passing close to the uterus and its blood vessels. During a hysterectomy, caesarean or other pelvic operation, these structures can be cut, burned, crushed or tied. Scar tissue from previous surgery or endometriosis can make that more likely.
Definition
Ureter means the thin tube that carries urine from each kidney to the bladder.
In plain terms: the pipes from your kidneys, which run very close to the uterus.
How common it is
A 2023 systematic review in the International Urogynecology Journal pooled studies on urinary tract injury. Per 100,000 operations, it estimated bladder injury at 267 and ureter injury at 9 for caesarean section; and for laparoscopic hysterectomy for benign conditions, bladder injury at 997 and ureter injury at 262.1 Injury rates were much higher in hysterectomy at the time of birth.1
Recognition during surgery
The review found most bladder injuries are recognised during surgery.1 An injury recognised in theatre can usually be repaired then, often with a catheter left in for a period afterwards. You should be told about it.
Why ureter injuries are found late
The same review found most ureter injuries are diagnosed after surgery, with a typical delay of about 10 to 14 days.1 Most need formal repair, and some people need several further procedures.1 Symptoms in the days after surgery can be put down to normal recovery, which is why listening to them matters.
Warning signs after surgery
Usually expected
- Some tummy pain, improving
- Light bleeding
- Stinging passing urine for a day or two after a catheter
In plain terms: sore, but better each day.
Call your surgeon today
- Pain on one side of your back
- Fever
- A swollen tummy
- Blood in your urine
In plain terms: ask to be seen and tested.
Urgent
- Constant leaking from the vagina
- Passing very little urine
- High fever or feeling very unwell
In plain terms: go to emergency and say what surgery you had.
Fistulas
A fistula is an abnormal connection, for example between the bladder or ureter and the vagina, which causes constant leaking of urine. It can develop days or weeks after surgery. It is distressing but can usually be repaired by a specialist.
Repair
Ureter injuries are usually repaired by a urologist, often by reimplanting the ureter into the bladder, sometimes after a period with a stent or tube draining the kidney.1 Recovery can take months. Our guide to bladder damage after birth covers a related injury.
Questions to ask
- Was my bladder or ureter checked during surgery?
- Could my symptoms be a urinary tract injury?
- Should I have a scan of my kidneys and ureters?
- Who will repair it, and what will that involve?
The emergency doctor ordered a CT scan that night. My right ureter had been cut, and urine was collecting in my abdomen and leaking out through the top of my vagina.
I had a tube put into my kidney through my back, and three months later a urologist reimplanted the ureter. In between, I lived with a bag.
The operation note from the hysterectomy said “ureters identified bilaterally”, but there was nothing to say they had been checked at the end. The ward notes from day five recorded “R flank pain, T 38.1, reassured”.
My partner read that line twice. “Reassured,” he said. “You had a temperature and kidney pain.” I’m mostly well now. I want to understand those four days.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.2 Our step-by-step guide to getting your medical records in Australia walks you through it.
| Record | Why it matters |
|---|---|
| Consent form | Shows whether bladder and ureter injury was explained. |
| Operation note | Records the procedure, any difficulty, and whether bladder and ureters were checked. |
| Ward and discharge notes | Show your symptoms, temperature and urine output. |
| Phone and emergency notes | Show what you reported after going home. |
| Scans | CT or other imaging that found the injury. |
| Urology records | Show the repair and your recovery. |
| Your own diary, photos and messages | Notes made at the time are evidence too. Keep them. |
How the law looks at it
A bladder or ureter injury during pelvic surgery is a recognised risk and is not automatically negligence. It can happen in careful hands, especially when anatomy is difficult. The legal questions are usually whether the injury should have been avoided in the circumstances, and whether it was recognised and treated promptly when symptoms appeared.
A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))3, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)4, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)56. Our guide to how a medical negligence claim works explains each one in plain terms.
In a urinary tract injury case, the questions might be: was the risk explained? Was the surgery performed with appropriate care, given your anatomy? Was the injury recognised during surgery when it could have been? When you reported fever, flank pain or leaking, were tests done promptly?
In plain terms, the question is whether earlier recognition would probably have meant a simpler repair, a shorter illness, or avoided lasting damage.
For a hysterectomy or other pelvic surgery, that would usually include the risk of bladder and ureter injury, and what would happen if it occurred.
Who can claim, and when
The person injured can claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.
More: complaint or claim? · how a claim is paid for · what a claim can cover
In my practice
In urinary tract injury files, the gap is often in the days after surgery. A temperature and flank pain are recorded, and the response is reassurance. By the time leaking starts, the injury has been present for a week or more. Most people tell me they were made to feel they were overreacting. Reading the observations chart usually shows they weren’t.
Both things can be true
Your surgeon may have done a difficult operation carefully, and the injury may have been hard to avoid. The response to your symptoms afterwards may still have fallen short. Both can be true.
The bigger picture
You can check a practitioner on the Ahpra public register,7 and complaints in NSW can go to the Health Care Complaints Commission.8 See also our guides to bowel injury during surgery, endometriosis laparoscopy and emergency hysterectomy after birth.
Support
You don't have to work through this alone. These services can help:
- Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)9
- Beyond Blue, anxiety and depression support: 1300 22 4636
- Medicare Mental Health, help finding mental health support: 1800 595 212
- healthdirect, 24-hour nurse advice: 1800 022 222
- Health Care Complaints Commission (NSW): 1800 043 159
A woman told she was just sore now knows what her temperature chart was saying. You deserve that clarity too.
With care,
Rosemary
Frequently asked questions
How common is bladder injury during hysterectomy?
Depends on the type. One review estimated about 1 in 100 for laparoscopic hysterectomy for benign conditions.
Why are ureter injuries often found late?
Most aren’t visible during surgery and show up days later, often 10 to 14 days.
What are signs of a ureter injury after surgery?
Fever, flank pain, a swollen tummy, leaking urine from the vagina or passing little urine.
What is a fistula?
An abnormal connection, for example between the bladder and vagina, causing constant leaking.
Can a ureter injury be repaired?
Usually, by a urologist, often by reimplanting the ureter into the bladder.
Can I claim for a bladder or ureter injury?
You may well have a claim if the injury or the delay in finding it was due to care below the accepted standard.
Questions about an injury during surgery?
When you're ready, and not before, I can look at what happened and help you understand your options.
Surgical and hospital care guides
- “I was leaking from the wrong place”: Bladder and ureter injuries during surgery (you are here)
- “My oxygen dropped and nobody told me”: When colonoscopy sedation goes wrong
- Hypoxic brain injury during surgery or sedation
- “They said it was a pulled muscle”: Missed blood clots (DVT and PE)
- Sepsis and leg removal: when is that medical negligence?
Part of our guide to surgical errors and hospital negligence. Not sure where you stand? Try the free claim checker.
References
- Wei G, Harley F, O’Callaghan M, et al. Systematic review of urological injury during caesarean section and hysterectomy. International Urogynecology Journal. 2023;34:371–389.
- Information and Privacy Commission NSW. Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW) s 5O, Standard of care for professionals.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Australian Commission on Safety and Quality in Health Care. Informed consent.
- Australian Health Practitioner Regulation Agency. Register of practitioners.
- Health Care Complaints Commission NSW. Home page.
- healthdirect Australia. Mental health helplines.
Stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
Dr Rosemary Listing, PhD (Law), Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates. Rosemary's doctorate examined patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified. About Rosemary.
Last updated: 10 November 2026 · First published: 10 November 2026 · Next review: May 2027
Cite this article: Listing R. “I was leaking from the wrong place”: Bladder and ureter injuries during surgery. Reframe Legal. Published 10 November 2026. https://reframelegal.com/bladder-injury-during-surgery/
This article is general information, not legal or medical advice. It does not create a lawyer–client relationship. Speak to your treating clinicians about your health, and get legal advice about your own situation.
If you are in danger or need urgent medical help, call 000. For crisis support, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
