Risk factors for lower urinary tract injury at the time of hysterectomy for benign reasons.
OBJECTIVE
To identify risk factors associated with lower urinary tract injury at the time of performing hysterectomy for benign indications.


METHODS
We conducted a multi-center case-control study of women undergoing hysterectomy for benign disease. Cases were identified via ICD-9 codes for lower urinary tract injury at the time of hysterectomy from 2007 to 2011: controls were two subsequent hysterectomies following the index case in the same institution that did not have lower urinary tract injury. Logistic regression was used to perform univariate and multivariate comparisons between groups.


RESULTS
At 7 centers, 135 cases and 270 controls were identified. Cases comprised 118 bladder injuries and 25 ureteral injuries; 8 women had both bladder and ureteral injury. Bladder injury was associated with a history of prior cesarean section OR 2.9 (95% CI 1.7-5), surgery by a general obstetrician and gynecologist OR 2.4 (95% CI 1.2-5.2), and total abdominal hysterectomy OR1.9 (95%CI 1.06-3.4). Ureteral injury was more likely among women who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) OR 10.4 (95%CI 2.3-46.6) and total abdominal hysterectomy (TAH) OR 4.7 (95% CI 1.4-15.6).


CONCLUSIONS
Bladder injury at the time of benign hysterectomy is associated with a prior history of Cesarean section and TAH as well as surgery by generalist OB-GYN; ureteral injury is associated with LAVH and TAH.
Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, New York, 10029, NY, USA, mamta.mamik@gmail.com.
Mamta M
MM
Mamik
Danielle
D
Antosh
Dena E
DE
White
Erinn M
EM
Myers
Melinda
M
Abernethy
Salma
S
Rahimi
Nina
N
Bhatia
Clifford R
CR
Qualls
Gena
G
Dunivan
Rebecca G
RG
Rogers
D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D006176:Gynecology; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy; D008875:Middle Aged; D009774:Obstetrics; D012189:Retrospective Studies; D012307:Risk Factors; D014521:Urethra / Q000293:injuries*; D001743:Urinary Bladder / Q000293:injuries*