Duong et al identified risk factors for the development of a vulvovaginal fistula (VVF) following an incidental cystotomy during a benign hysterectomy. These can help to identify a patient who may require more aggressive management. The authors are from Emory University in Atlanta.
Patient selection: bladder injury during a benign hysterectomy
Risk factors for development of a VVF:
(1) current smoker
(2) large perioperative blood loss (> 800 mL)
(3) Grade V bladder injury (using the American Association for the Surgery of Trauma or AAST classification of I to V) = laceration extending into the bladder neck or ureteral orifice
(4) larger uterus (> 500 g)
This is one more reason for a person who is a current smoker to stop smoking (for at least 4 weeks) prior to surgery.
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