Lower urinary tract injuries during hysterectomy in women with a history of two or more cesarean deliveries: a secondary analysis.

INTRODUCTION AND HYPOTHESIS: 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.