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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