ABSTRACT
OBJECTIVES: : To evaluate risk factors for incidental cystotomy at the time of a hysterectomy. METHODS: : All hysterectomies performed between January 1, 2000 and May 31, 2004 were reviewed. Demographic and operative data were abstracted from medical records. Cases were patients with cystotomies while controls were those without bladder injury. Categorical variables were analyzed with the χ or Fisher exact test (where applicable) while the Student t test was used for continuous data. Logistic regression was used for multivariate analysis. RESULTS: : During the study period, 1424 hysterectomies were performed (50% abdominally, 45% vaginally, and 5% laparoscopically assisted vaginal). Thirty-four (2.4%) cystotomies occurred. Risk factors for incidental cystotomy included prior cesarean delivery (adjusted OR: 2.86, 95% CI: 1.39-5.92), pelvic adhesions (adjusted OR: 2.43, 95% CI: 1.11-5.31), and vaginal hysterectomy (adjusted OR: 2.63, 95% CI: 1.18-5.87). CONCLUSIONS: : Prior cesarean delivery, pelvic adhesive disease, and vaginal hysterectomy are independent risk factors for incidental cystotomy at the time of a hysterectomy.
ABSTRACT
OBJECTIVE: We sought to evaluate risk factors for vesicovaginal fistula (VVF) after incidental cystotomy during benign hysterectomies. STUDY DESIGN: All benign hysterectomies between January 2000 and May 2004 were reviewed. Demographic and operative data were abstracted. Cystotomies were graded using the American Association for the Surgery of Trauma (AAST) system. Patients developing VVF after cystotomy were compared to those who did not. Categorical variables were analyzed with Fisher exact test while Student t test was used for continuous data. RESULTS: A total of 1317 benign hysterectomies were reviewed (46% abdominal, 48% vaginal, and 6% laparoscopically assisted vaginal). In all, 34 cystotomies occurred with 4 (11.7%) developing a VVF. Patients developing VVF were more likely to have an AAST grade V cystotomy (75% vs 7%; P = .004). Patients developing VVF trended toward greater tobacco use, larger uterine size, and more operative blood loss. CONCLUSION: Patients with an AAST grade V cystotomy are at increased risk for VVF formation.
