Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum

Abstract

To evaluate the association between prophylactic ureteral stent placement at the time of hysterectomy for placenta accreta spectrum and genitourinary injury. METHODS:We conducted a retrospective cohort study of patients with placenta accreta spectrum who underwent hysterectomy at two referral centers from 2001 to 2021. The exposure was prophylactic ureteral stent placement. The primary outcome, genitourinary injury, was a composite of bladder injury, ureteral injury, or vesicovaginal fistula. Secondary outcomes included components of the primary outcome. We evaluated differences between groups using x 2 and t test. To evaluate differences in the primary outcome, we reported odds ratios (ORs) and adjusted odds ratios (aORs) using multivariable logistic regression analyses to control for potential confounding variables. We used a Cochran-Armitage x 2 trend test to evaluate difference in stent use and injury over time.

Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta‐analysis

“…The initial search resulted in 856 articles, of which 758 were excluded, as the reported outcomes were not relevant, leaving 98 studies that were obtained for full‐text review. An additional 36 articles were excluded after full review, leaving 62 articles for the systematic review 18–79 (Figure 1 and Tables 1 and S2). Of these, 56 studies were included in the meta‐analysis 18–24, 26–33,35–44,46–61,63–69,71–77,79 , while six studies were excluded from the pooled analysis due to potential overlap in populations.…”

“…An additional 36 articles were excluded after full review, leaving 62 articles for the systematic review 18–79 (Figure 1 and Tables 1 and S2). Of these, 56 studies were included in the meta‐analysis 18–24, 26–33,35–44,46–61,63–69,71–77,79 , while six studies were excluded from the pooled analysis due to potential overlap in populations. Some of the included studies were still at risk of overlap; in these cases, national studies were prioritized for inclusion, unless they did not report on the evaluated outcome.…”

Placenta Accreta Spectrum

“…72 Depending on the surgical plan, some centers routinely use preoperative or intraoperative cystoscopy to delineate the position of the bladder and ureters, and prophylactic ureteral stent placement has been associated with reduced incidence of genitourinary injury in patients with PAS undergoing hysterectomy. 73…”

Use of an aortic balloon to achieve uterine conservation in a case of placenta accreta spectrum: A case report

“…PAS is associated with a high rate of caesarean hysterectomy [ 2 , 4 , 19 ]. While this may be the safest approach in some cases, uterus-conserving approaches have several benefits.…”

“…Placenta accreta spectrum (PAS) is a term used to describe abnormal trophoblastic invasion into the myometrium and sometimes to or beyond the uterine serosa [ 1 ]. The condition is associated with a significant risk of massive haemorrhage and a high rate of patients undergoing caesarean hysterectomy [ [2] , [3] , [4] ]. More recently, uterus-preserving techniques, such as en-bloc myometrial and placental resection, have been described as an alternative to caesarean hysterectomy [ 5 ].…”