Background/Aim: Placenta percreta is a rare event, but it poses serious problems due to potential hemorrhagic events. We report a particular case of placenta percreta with massive hematuria due to maternal bladder invasion, and describe the surgical protocol performed that resulted in an excellent outcome. Case Report: A 33-yearold patient, at 27 th weeks gestational age, presented in the emergency room of the Urology Department with urinary blood clot acute retention, because of massive hematuria from a placenta percreta with bladder invasion. After extracting the clots from the bladder, and coagulation of an area of venous ectasies of the posterior wall, hematuria ceased, but appeared after two days, necessitating again the bladder clots removal and coagulation. A surgical team with gynecologists, urologists, anesthesiologists and a neonatologist was composed, and after bilateral ureteral double J insertion, cesarean section was performed followed by hemostatic hysterectomy and partial cystectomy, bilateral internal iliac artery ligature and repair of the bladder wall. The postoperative evolution was without incidents; the Foley catheter was removed in the 14 th postoperative day. Conclusion: In the context of a massive hematuria of a pregnant woman, the urologist must always consider a diagnosis of complicated placenta percreta.Placenta percreta represents the most severe form of abnormal trophoblastic adherence beyond the decidua basalis, among the three representatives of the placenta accreta spectrum (PAS), a rare condition with reported incidence of 1/500 to ½/500 pregnancies (1, 2). PAS includes 75-80% cases of placenta accreta vera (less than 50% myometrial invasion by the trophoblast), 17% cases of placenta increta (more than 50% myometrial invasion by the trophoblast), and 5% cases of percreta (invasion of uterine serosa and neighboring pelvic organs) (2, 3). Moreover, the abnormal adherence can be complete (throughout the entire placenta), partial (limited to only one or more cotyledons), or focal (in isolated areas) (4).More than 2 caesarean sections (CS), including shorter intervals between previous CS and current pregnancy (less than 2 years), and concurrent placenta praevia (in 75% of cases) are the most common known risk factors, followed by advanced maternal age, multiparity, endometritis, hypertension, assisted reproductive technology, submucosal leiomyomas, other uterine surgeries and anomalies (poor quality of scarring and CS performed on long time ruptured membranes leading to chorioamniotitis), smoking (3,(5)(6)(7)(8)(9). Because of the rise in the numbers of CS performed in recent years, the risk of PAS disorders is increasing up to 10 times in the last 50 years (10,11).The information regardless of treatment of the placenta percreta with bladder invasion are limited, because of the exceptional rarity of this event. Approximatively 70 cases are reported as case presentation, the largest series comprising 54 patients (12).
