Risk factors for lower urinary tract injury at the time of hysterectomy for benign reasons

Mamta M. Mamik, Danielle Antosh, Dena E. White, Erinn M. Myers, Melinda Abernethy, Salma Rahimi, Nina Bhatia, Clifford R. Qualls, Gena Dunivan, Rebecca G. Rogers

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objectives: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1031-1036
Number of pages6
JournalInternational Urogynecology Journal and Pelvic Floor Dysfunction
Issue number8
StatePublished - Aug 2014


  • Bladder injury
  • Hysterectomy
  • Risks
  • Ureter injury

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology


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