Urological outcomes and management of abnormal placental presentations: a retrospective study at a Lebanese center.

BACKGROUND

Placenta Accreta Spectrum (PAS) involves abnormal placental adhesions, leading to severe complications like postpartum hemorrhage. Such cases often require cesarean hysterectomies, which are associated with significant risks of urinary tract injuries.

METHODS

This retrospective study reviewed medical records of 220 patients diagnosed with PAS at Rafik Hariri University Hospital, Beirut, from 2007 to 2022. Patients were categorized based on ultrasound findings into two groups: Group 1 included 84 with Placenta Previa Accreta; Group 2 comprised 72 with Low Risk Placenta Previa, 52 with High Risk, and 12 with Placenta Accreta involving bladder injury. We assessed preoperative, intraoperative, and postoperative management.

RESULTS

Of the 187 patients undergoing hysterectomy, 60 (32%) experienced urinary tract injuries, including bladder and ureteral injuries. Despite significant surgical risks, a multidisciplinary approach effectively managed patient care, preventing urinary tract infections.

CONCLUSION

Managing PAS cesarean hysterectomy poses a substantial risk of urinary tract injuries, primarily due to altered pelvic anatomy. Prophylactic ureteral stent placement, tailored to each patient, along with rigorous postoperative monitoring, is crucial to mitigate complications like urinary infections and genitourinary fistulae.