Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy
Presented at the 35th Annual Scientific Meeting of the Society of Gynecologic Surgeons, New Orleans, LA, March 30-April 1, 2009.
Received 23 December 2008; received in revised form 19 May 2009; accepted 23 June 2009. published online 17 August 2009.
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.
Section of Urogynecology and Pelvic Reconstructive Surgery, Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
Cite this article as: Duong TH, Gellasch TL, Adam RA. Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy. Am J Obstet Gynecol 2009;201:512.e1-4.
ABSTRACT