Objective

The main purpose of this study was to report the incidence of lower urinary tract injuries (UTI) during cesarean section (CS) hysterectomy in cases of Placenta Accreta Spectrum (PAS) disorders.

Study design

Retrospective analysis including all women with a prenatal diagnosis of PAS between January 2010 and December 2020. A dedicated multidisciplinary team was involved to define a tailored management for each patient. All relevant demographic parameters, risk factors, degree of placental adhesion, type of surgery, complications and operative outcomes were reported.

Results

One hundred and fifty-six singleton gestations with a prenatal diagnosis PAS were included in the analysis. 32.7% of cases were classified as PAS 1 (grade 1-3a FIGO classification), 20.5% as PAS 2 (grade 3b FIGO classification) and 46.8% as PAS 3 (grade 3c FIGO classification). A CS hysterectomy was performed in all cases. Surgical complication occurred in seventeen cases (0% in PAS 1, 12.5% in PAS 2 cases and in 17.8% in PAS 3). The incidence of UTI in our series was 7.6% in all women with PAS, including 8 cases of bladder and 12 of ureteral lesion, and 13.7 % in those with PAS 3 only.

Conclusion

Despite advances in prenatal diagnosis and management, surgical complications, mainly those involving the urinary system, still occur in a significant proportion of women undergoing surgery for PAS. The findings from this study highlight the need for a multidisciplinary management of women with PAS in centers with high expertise in prenatal diagnosis and surgical management of these conditions.

中文翻译：

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植入性胎盘谱系疾病手术期间的尿路损伤

客观的

本研究的主要目的是报告植入性胎盘谱系 (PAS) 疾病的剖宫产 (CS)子宫切除术中下尿路损伤 (UTI)的发生率。

学习规划

回顾性分析包括 2010 年 1 月至 2020 年 12 月期间所有产前诊断为 PAS 的女性。一个专门的多学科团队参与其中，为每位患者制定量身定制的治疗方案。报告了所有相关的人口统计参数、危险因素、胎盘粘连程度、手术类型、并发症和手术结果。

结果

分析中纳入了 156 例产前诊断为 PAS 的单胎妊娠。32.7% 的病例被分类为 PAS 1（FIGO 分类1-3a 级），20.5% 为 PAS 2（ FIGO 分类3b 级），46.8% 为 PAS 3（FIGO 分类3c 级）。所有病例均进行了 CS 子宫切除术。17 例出现手术并发症（PAS 1 例中为 0%，PAS 2 例中为 12.5%，PAS 3 例中为 17.8%）。在我们的系列中，所有患有 PAS 的女性中 UTI 的发生率为 7.6%，其中包括 8 例膀胱病变和 12 例输尿管病变，而仅患有 PAS 3 的女性中 UTI 的发生率为 13.7%。

结论

尽管产前诊断和管理取得了进步，但在接受 PAS 手术的女性中，很大一部分仍然会出现手术并发症，主要是涉及泌尿系统的并发症。这项研究的结果强调，需要在产前诊断和手术治疗方面具有高度专业知识的中心对患有 PAS 的女性进行多学科管理。