I have been performing vaginal surgery of all types for more than 15 years and perform hysterectomy almost exclusively via the vaginal route. Clearly requiring several surgeries including a cystectomy would suggest that there was a significant problem that developed after the initial surgery. Having a suture enter the bladder that is inserted as part of the vaginal cuff closure is a known complication but does not usually lead to the type of extreme problems that seem to be described. I have served as an expert in several cases involving the formation of vesicovaginal or ureteral vaginal fistulas after both abdominal and vaginal hysterectomy. I have never seen a patient require this many corrective surgeries following this type of injury and this might indicate that something went severely wrong here. As a fellowship trained urogynecologist, I have both expertise in the operations that are alleged to have caused the problem and in the proper evaluation and treatment of urinary tract injury following any sort of surgery, particularly gynecologic surgery.