Nearly half of newly diagnosed cases of bladder cancer are low grade, noninvasive, and papillary tumors. The standard treatment for non-muscle-invasive bladder cancer (NMIBC) has been transurethral resection of the bladder tumor (TUR-BT) with or without adjuvant intravesical instillation (IVI) of chemotherapy or Bacillus Calmette-Guerin (BCG) therapy. NMIBC is known to be associated with high rates of recurrence and risk of progression. In this study, we have retrospectively analyzed the clinical outcome of initially diagnosed multiple low-grade Ta tumors, with a special focus on tumor recurrence and worsening progression (WP) pattern. We retrospectively reviewed 42 patients with primary, multiple, low-grade Ta bladder cancer. We defined WP as confirmed high-grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinico-pathological factors and tumor recurrence as well as WP pattern were analyzed. Tumor recurrence and WP occurred in 23 (54.76%) and 8 (19.04%) patients during follow-up (median follow-up: 57.38 months), respectively. WP to high grade/stage was seen in 8 patients. Multivariate analysis demonstrated that use of tobacco ( < 0.0001) and absence of IVI ( < 0.0001) were significant risk factors for tumor recurrence. The 5-year recurrence-free survival rate for non-tobacco users (74.0%) was significantly higher than that for tobacco users (42.5%, = 0.0001), and also higher for patients receiving intravesical instillation (84.2 vs. 30.0% without IVI, = 0.0001). Recurrence is common in patients with low-grade, Ta bladder cancer, especially in the setting of multiplicity. Recurrences occurred in 54.76% of patients and WP occurred in 19.04% of patients. Use of tobacco and non-use of IVI were strongly associated with high recurrence rate.

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Placenta accreta spectrum, is characterized by abnormal placental adherence to the myometrium. Depending on the depth of trophoblastic growth, it is classified into placenta accreta, placenta increta, and placenta percreta. This condition is associated with life-threatening hemorrhage, resulting in high maternal and neonatal morbidity and mortality. Placenta accreta usually presents with vaginal bleeding during difficult placental removal in the third trimester. Placenta accreta spectrum is very rarely present in the first trimester. Severe forms may complicate first-trimester pregnancy losses, causing profuse postcurettage hemorrhage. A 28-year-old lady with one living issue by cesarean section who had undergone a dilatation and curettage (D&C) 2 months ago for missed abortion, came with the complaints of prolonged vaginal bleeding following the procedure. On pelvic examination, the uterus was bulky, partly firm on one side, and soft on the other. Ultrasound examination revealed it to be a bicornuate uterus with retained products in one of the horns. Magnetic resonance imagining was suggestive of lateral cervical fibroid. Diagnostic laparoscopy revealed it to be a left lateral cervical mass. Total laparoscopic hysterectomy was performed. On histopathological examination, specimen revealed necrotic placenta infiltrating the endocervix and isthmus. Placenta accreta is a rare problem and difficult to diagnose in the first trimester. It can occur when there are risk factors or if there are ultrasound markers of the first trimester suspicious of the adherent placenta. A diagnosis of placenta accreta spectrum needs to be considered when there is post-D&C prolonged or heavy vaginal bleeding.