This chapter discusses bladder injuries and other complications during surgical procedures. Surgical anatomy of the ureter, incidence of ureteral injury, incidence of ureteral injury, diagnosis, and its management, is discussed. Management of specific injury such as ureteral ligation, partial ureteral transection, and total transection, is presented. The most effective way to prevent ureteral injury during pelvic laparotomy is to identify the ureters as they enter the pelvis over the bifurcations of the common iliac arteries and to trace the pelvic course of each ureter during dissection of the retroperitoneal spaces. Bladder injuries, their intraoperative recognition, postoperative recognition, clinical presentation, fistula site, diagnosis and investigations, and treatment, is presented. In difficult cases and with large fistula, bisection of the bladder to the level of the fistula is done, fistula is excised in toto and vagina and bladder closed in separate layers with omental interposition. Vesico-uterine and vesico-cervical fistula is suspected if the escape of urine through the external cervical os. Surgery involves the anatomic dissection and separation of the bladder from the uterus.