Damage to the efferent urinary passages during abdominal or vaginal hysterectomy cannot always be prevented no matter how carefully one may proceed preoperatively and intraoperatively. However, all possibilities of avoiding complications or at least of recognising and eliminating them before surgery, must be explored. Nevertheless, formation of vesicovaginal or ureterovaginal fistulas or of a congested ureter will be rare. In such cases, one cannot jump to the conclusion of mismanagement or a therapeutic error from the mere occurrence of damage. In each individual case, there must be an expertise and a legal judgment as to whether there has been any infringement of the legal requirement to exercise all possible medical care lege artis. Claims for damages are justified only if the conditions of an individual case show, on close examination, that such care had not been exercised.