An abnormal connection (fistula) between the bladder and the vagina can sometimes occur following hysterectomy known as a vesicovaginal fistula. This is most commonly caused by accidental perforation of the bladder with a suture, but can also sometimes occur when a small haematoma (collection of blood) develops in the tight space between the base of the bladder and the top of the vagina resulting in infection and subsequent tissue damage. In the latter, urinary leakage will not become apparent until about 5-10 days following surgery.

The ureters are two thick, muscular tubes that convey urine from the kidneys to the bladder. Ureteric damage, resulting in a urine leak or obstruction, most commonly occurs at the time of surgery due to accidental cutting, misplacement of a suture (through or around the ureter) or by diathermy. However, it can also happen 10 days or more after surgery if the ureter is deprived of a sufficient blood supply resulting in tissue necrosis. Obstruction of the ureter should be suspected if the patient complains of loin pain (caused by back pressure to the kidney) in the immediate post-op period.

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