ObjectiveTo report the occurrence of urologic complications in women undergoing surgery for placenta accreta spectrum (PAS) disorders.MethodsMedline, Embase and Cochrane databases were searched electronically up to 1st of November 2022. Studies reporting cohort on surgical management and outcome of PAS. Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle‐Ottawa scale for observational studies, with difference agreed by consensus. The primary outcome was the overall occurrence of urologic complications in women undergoing surgery for PAS. Secondary outcomes were overall cystotomy, intentional cystotomy, unintentional cystotomy, ureteral damage, ureteral fistula, vesicovaginal fistula. All these outcomes were explored in the overall population of patients undergoing hysterectomy for PAS disorders. In addition, we performed sub‐group analyses according to the severity of PAS at histopathology (placenta accreta/increta and percreta), type of intervention (planned vs emergency), ureteral stent placing and number of cases per year. Random‐effect meta‐analyses of proportions were used to analyze the data.ResultsSixty‐two studies were included. Urologic complications occurred in 15.29% (95% CI, 13.0‐17.2) of cases. Cystotomy complicated 13.02% (95% CI, 9.2‐17.3) of surgical operations. Intentional cystotomy was required in 5.58% (95% CI, 2.7‐9.3) of cases while damage to the bladder occurred in 7.40% (95% CI, 4.3‐11.2) of cases. Urologic complications occurred in 19.36% (95% CI, 16.3‐22.7) of cases undergoing hysterectomy and 12.22% (95% CI, 7.5‐17.8) of those having conservative treatment. In the sub‐group analyses, urologic complications occurred in 9.42% (95% CI, 5.4‐14.4) of women with placenta accreta‐increta and 38.52% (95% CI, 21.6‐57.0) of those described as placenta percreta and were mainly represented by cystotomy (5.53% (95% CI, 0.6‐15.1) in women with placenta accreta increta and 21.97% (95% CI, 15.4‐45.5) in the placenta percreta subgroup). Urologic complications occurred in 15.44% (95% CI, 8.1‐24.6) during planned procedures and in 24.61% (95% CI, 13.0‐38.5) during emergency intervention. The incidence of urologic complications was similar to that reported in the primary analysis in studies reporting >10 cases per year.ConclusionsPatients undergoing surgery for PAS disorders are at high‐risk of urologic complications, mainly cystotomy. The incidence of these complications is higher in patients described as having a placenta percreta at birth and in case of emergency surgical intervention. The high heterogeneity highlights the need to use standardized protocols for the diagnosis of PAS to identify prenatal imaging signs associated with a risk of urologic morbidity at delivery.This article is protected by copyright. All rights reserved.
