title: A multicenter study of vesicovaginal fistula following incidental cystotomy during benign hysterectomies.
abstract: OBJECTIVE
  To evaluate factors for vesicovaginal fistula (VVF) formation following incidental cystotomies during benign hysterectomies.
  
  
  METHODS
  Hysterectomies performed at two university centers between January 1, 2000 and December 31, 2008 were reviewed. Demographic and operative data were abstracted. Patients who developed VVF were compared to those with no VVF.
  
  
  RESULTS
  During the study period, 5,698 hysterectomies performed for benign indications were identified. One hundred two (1.8%) cystotomies occurred with 6 (5.9%) developing a VVF. Patients with VVF were more likely to have uteri weighing > 250 g (83% vs. 36%, P = 0.03), had longer surgeries (317 ± 82 vs. 208 ± 10 min, P = 0.02) and more ureteral injuries (33% vs. 1%, P = 0.009). American Association for the Surgery of Trauma (AAST) grade V bladder injuries (OR, 93.00; 95% CI, 10.30-838.92) were associated with VVF formation.
  
  
  CONCLUSIONS
  Patients with AAST grade V bladder injuries are at increased risk for developing vesicovaginal fistulas following incidental cystotomies during benign hysterectomies.
authors.affiliation: Department of Gynecology and Obstetrics, Section of Urogynecology and Pelvic Reconstructive Surgery, Emory University School of Medicine, Glenn Memorial Building, 69 Jesse Hill Jr. Dr., SE, Atlanta, GA 30303, USA. thdmd@yahoo.com
authors.forename: Thinh H
authors.initials: TH
authors.lastname: Duong
authors.forename: David P
authors.initials: DP
authors.lastname: Taylor
authors.forename: G Rodney
authors.initials: GR
authors.lastname: Meeks
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D009929:Organ Size; D012307:Risk Factors; D013997:Time Factors; D014513:Ureter / Q000293:injuries; D001743:Urinary Bladder / Q000293:injuries*; D014599:Uterus / Q000033:anatomy & histology; D014719:Vesicovaginal Fistula / Q000209:etiology*