To evaluate risk factors for incidental cystotomy at the time of a hysterectomy.
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 χ2 or Fisher exact test (where applicable) while the Student t test was used for continuous data. Logistic regression was used for multivariate analysis.
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).
Prior cesarean delivery, pelvic adhesive disease, and vaginal hysterectomy are independent risk factors for incidental cystotomy at the time of a hysterectomy.
For women undergoing a hysterectomy, prior cesarean delivery, pelvic adhesive disease vaginal route of surgery increases the risk of an incidental cystotomy at the time of surgery.
From the Division of Gynecologic Specialties, Section of Urogynecology and Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
Reprints: Thinh H. Duong, MD, Emory University School of Medicine, Department of Gynecology and Obstetrics, Glenn Memorial Building, 69 Jesse Hill Jr. Dr., S.E., Atlanta, GA 30303. E-mail: email@example.com.