Benign gynaecology: ureteric injury at hysterectomy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Benign gynaecology: ureteric injury at hysterectomy

Sample item

On day 4 after a total abdominal hysterectomy for fibroids, a woman has flank pain, low-grade fever and a clear watery vaginal discharge. The fluid creatinine is much higher than serum creatinine, and methylene blue instilled into the bladder does not appear in the vagina. What is the most likely injury?

AVaginal cuff infection onlyBUreteric injury with a ureterovaginal fistulaCVesicovaginal fistulaDVault haematoma

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ureteric injury with a ureterovaginal fistula

The ureter is injured most often where it passes beneath the uterine artery, near the cervix, during clamping of the pedicles. Leakage of urine from the ureter appears as watery discharge with a high creatinine, and a negative bladder dye test points away from a vesicovaginal fistula. CT urography confirms it, and management is ureteric stenting or reimplantation.

Option by option

A. Vaginal cuff infection only
A cuff infection does not explain high fluid creatinine.
B. Ureteric injury with a ureterovaginal fistula (correct)
Correct. Urine leak with a normal bladder dye test indicates ureteric injury.
C. Vesicovaginal fistula
A vesicovaginal fistula would allow dye from the bladder to reach the vagina.
D. Vault haematoma
A haematoma would not give a urine-like discharge with a high creatinine.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Ureteric injury with a ureterovaginal fistula. The ureter is injured most often where it passes beneath the uterine artery, near the cervix, during clamping of the pedicles.

Why is "Vaginal cuff infection only" not the answer?

A cuff infection does not explain high fluid creatinine.

Why is "Vesicovaginal fistula" not the answer?

A vesicovaginal fistula would allow dye from the bladder to reach the vagina.

Why is "Vault haematoma" not the answer?

A haematoma would not give a urine-like discharge with a high creatinine.

What concept does this question test?

It tests Benign gynaecology: ureteric injury at hysterectomy in OBG. Leakage of urine from the ureter appears as watery discharge with a high creatinine, and a negative bladder dye test points away from a vesicovaginal fistula. CT urography confirms it, and management is ureteric stenting or reimplantation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Benign gynaecology: ureteric injury at hysterectomy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.