Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2232076. doi: 10.1080/14767058.2023.2232076.
Surgery for placenta accreta spectrum disorders is known to be associated with urologic morbidity. Although previous studies have shown preoperative ureteral stent placement might be useful for preventing the urologic morbidity, the patient's discomfort caused by it should not be ignored. Whether there is an alternative management strategy remains unknown. This study was to evaluate the effectiveness of ureteral stents and catheters in preventing urologic injury in patients with placenta accreta spectrum undergoing surgery.
We conducted a retrospective cohort study. All cases with diagnosed placenta accreta spectrum who underwent surgery at Peking University Third Hospital between January 2018 and December 2020 were collected and reviewed. They were divided into two groups according to the different management strategies for preoperative placement of ureteral catheters or stents. The primary outcome was urologic injury, which was defined as the presence of ureteral or bladder injury during and after surgery. Secondary outcomes included urologic complications within the first three months after surgery. The median (interquartile range) or proportions were reported for variables. The Man Whitney U test, chi-square test and multivariate logistic regression were used for analysis.
Ultimately, 99 patients were included in this study. Ureteral catheters were placed in 52 patients and ureteral stents were placed in 47 patients. Placenta accreta, placenta increta, and placenta percreta were diagnosed in three, 19, and 77 women, respectively. The hysterectomy rate was 52.53%. Overall, urologic injuries occurred in three patients (3.03%), including one case of combined bladder and ureteral injury (1.01%) and two cases of bladder injuries (2.02%). Only one ureteral injury occurred in a patient with a ureteral stent, which was recognized postoperatively ( = .475). All bladder injuries were vesical rupture which were recognized and repaired intraoperatively; one patient in the catheter group and two patients in the stent group ( = .929). After adjusting for confounding variables, multinomial regression analysis revealed no significant differences between the two groups in the incidence of bladder injuries(aOR: 0.695, 95% CI: 0.035-13.794, = .811). A lower risk of urinary irritation (aOR: 0.186, 95% CI: 0.057-0.605, = .005), hematuria (aOR: 0.011, 95% CI: 0.001-0.136, < .001), and lower back pain (aOR: 0.075, 95% CI: 0.022-0.261, < .001) was found in patients with ureteral catheters than in those with ureteral stents.
The ureteral stents didn't confer a protective benefit in the surgical management for placenta accreta spectrum compare with catheters; however, they did result in a higher incidence of postoperative urologic complications. Ureteral temporal catheters may be an alternative strategy for placenta accreta spectrum cases suspected with urinary tract involved prenatally. Moreover, clearly and explicitly reporting "double J stent" or "temporal catheter" is necessary for future researches.
已知胎盘植入谱系疾病的手术与泌尿科发病率有关。尽管先前的研究表明术前放置输尿管支架可能有助于预防泌尿科发病率，但由此引起的患者不适也不容忽视。是否存在替代管理策略仍不清楚。本研究旨在评估输尿管支架和导管在预防胎盘植入谱系疾病患者手术中泌尿科损伤的有效性。
我们进行了一项回顾性队列研究。收集并回顾了 2018 年 1 月至 2020 年 12 月期间在北京大学第三医院诊断为胎盘植入谱系疾病并接受手术的所有病例。根据术前放置输尿管导管或支架的不同管理策略，将他们分为两组。主要结局是手术期间和手术后出现输尿管或膀胱损伤。次要结局包括术后三个月内的泌尿科并发症。使用中位数（四分位距）或比例报告变量。使用曼惠特尼 U 检验、卡方检验和多变量逻辑回归进行分析。
最终，这项研究纳入了 99 名患者。52 名患者放置了输尿管导管，47 名患者放置了输尿管支架。3 名、19 名和 77 名妇女分别诊断为胎盘植入、胎盘植入和胎盘穿透。子宫切除术率为 52.53%。总的来说，有 3 名患者（3.03%）发生了泌尿科损伤，包括 1 例膀胱和输尿管联合损伤（1.01%）和 2 例膀胱损伤（2.02%）。只有 1 例输尿管支架患者发生输尿管损伤（ = .475）。所有膀胱损伤均为术中发现和修复的膀胱破裂，1 例在导管组，2 例在支架组（ = .929）。调整混杂变量后，多变量回归分析显示两组膀胱损伤发生率无显著差异（aOR：0.695，95%CI：0.035-13.794， = .811）。输尿管支架组术后发生尿路刺激（aOR：0.186，95%CI：0.057-0.605， = .005）、血尿（aOR：0.011，95%CI：0.001-0.136， < .001）和腰痛（aOR：0.075，95%CI：0.022-0.261， < .001）的风险较低。
与导管相比，输尿管支架在胎盘植入谱系疾病的手术管理中没有提供保护作用；然而，它们确实导致术后泌尿科并发症的发生率更高。对于术前怀疑有尿路受累的胎盘植入谱系疾病患者，输尿管临时导管可能是一种替代策略。此外，未来的研究还需要明确和明确地报告“双 J 支架”或“临时导管”。
