Evaluation of short-term and long-term results of the ACAR-style bladder suture approach during uterus-sparing surgery and hysterectomy in cases of placenta percreta.

PURPOSE

This study evaluated the short- and long-term results of ACAR-style bladder suturing performed during uterus-sparing surgery or hysterectomy in patients with placenta percreta and bladder invasion.

METHODS

This retrospective cohort study included pregnant women who underwent a cesarean section at the University Gynecology and Obstetrics Clinic between January 2018 and March 2023, diagnosed with placenta percreta with bladder invasion, for which bladder dissection was not possible. In this study, patients with placenta percreta who underwent uterine-sparing surgery or subtotal hysterectomy received an ACAR-style bladder suture. We evaluated the intraoperative and postoperative morbidity and mortality in all cases. We questioned and recorded urinary symptoms such as stress or urge incontinence, nocturia, and urinary frequency during follow up.

RESULTS

A total of thirty-eight patients were included in the study. The mean age of the pregnant women in the study was 37.4 ± 4.12 years. The average surgery time was 149.47 ± 65.57 min, the average hospital stay was 9.53 ± 8.66 days, the intraoperative transfusion rate was 65.8% (n = 25), and the postoperative transfusion rate was 47.4% (n = 18). The subtotal hysterectomy rate was 13.1% (n = 5). Evaluation of the post-operative urinary functions in these cases revealed an increase in complaints of urinary incontinence, nocturia, and urgency compared to the preoperative period. While the incontinence rate was 7.9% (n = 3) before, this rate increased to 31.6% (n = 12) after the bladder suture and this increase was statistically significant (p = 0.013). The rate of nocturia was 23.7% (n = 9) before the bladder suture and 50.0% (n = 19) after the bladder suture and this increase was statistically significant (p = 0.008).

CONCLUSION

In cases with bladder invasion and placenta percreata, cystostomy can be performed and bladder suture by ACAR method can be used as an alternative to bladder dissection and cystectomy.