BackgroundInjury to the urinary tract during pelvic surgery can have devastating consequences. Intraoperative recognition of these injuries by endoscopy can lead to immediate correction and a significant decrease in morbidity.AimThis study evaluated the value of intraoperative endoscopy in the identification of urinary tract injuries during surgeries for prolapse and incontinence.MethodA retrospective chart review was performed on 240 patients who underwent urogynecologic surgery that included routine bladder endoscopy. After approval was obtained from our Institutional Review Board, an analysis of the patient's history, operative report, and postoperative care was completed.ResultsTwo hundred forty consecutive urogynecologic surgeries that included routine bladder endoscopies were performed. Seven occult urinary tract injuries were recognized by endoscopic evaluation. Additionally, six patients with other clinically significant findings were noted. Urinary tract injuries uncovered were limited to the bladder. These included five patients who had suture material and one patient who had a Gortex (W. L. Gore and Associates, Flagstaff, AZ) graft in the bladder. In addition, one patient had a tuck in the bladder from an unsatisfactory stitch placement. There were no ureteral or urethral injuries found in this study. The overall urinary tract injury rate for this population was 2.9%. However, if other clinically significant findings are included, the overall recognition rate using routine bladder endoscopy was 5.4%.ConclusionsThis study suggests that routine intraoperative bladder endoscopy during urogynecologic procedures is valuable in the recognition of urinary tract injuries.