title: Lower urinary tract injuries during hysterectomy in women with a history of two or more cesarean deliveries: a secondary analysis.
abstract: OBJECTIVE
  To evaluate lower urinary tract injuries in women with ≥2 prior cesarean deliveries (CD) undergoing benign hysterectomies.
  
  
  METHODS
  This is a planned secondary analysis of all hysterectomies performed from 2000 to 2009 at Grady Memorial Hospital. Demographic, operative and postoperative data were reviewed. Women undergoing benign hysterectomies with ≥2 CD were compared with women with no prior CD. Categorical variables were analyzed using Chi-squared or Fisher's exact test, while Student's t test was used for continuous variables. Logistic regression was used for multivariate analysis.
  
  
  RESULTS
  2,214 women met the inclusion criteria (284 with ≥2 CD, 1,930 with no CD). The proportion of women having vaginal hysterectomy, abdominal hysterectomy, and laparoscopically assisted vaginal hysterectomy were 38%, 53%, and 9% respectively. Women with multiple CD had greater blood loss and longer operative times. They also required more transfusions (23% vs 15%, P = 0.001) and developed more abdominal wounds (6% vs 3%, P = 0.002) or urinary infections (6% vs 3%, P = 0.03). Women with ≥2 CD were at greater risk of incidental cystotomies (OR: 8.55, 95% CI: 3.98-18.36).
  
  
  CONCLUSIONS
  Multiple prior cesarean deliveries increase a woman's risk of cystotomy during hysterectomy. They also require more transfusions and develop more urinary or abdominal wound infections.
authors: Emory University School of Medicine, Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Atlanta, GA, USA, thdmd@yahoo.com.
authors: Thinh H
authors: TH
authors: Duong
authors: Tamula M
authors: TM
authors: Patterson
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D014521:Urethra / Q000293:injuries*; D001743:Urinary Bladder / Q000293:injuries*; D014552:Urinary Tract Infections / Q000453:epidemiology