Placenta percreta with urinary tract involvement: the case for a multidisciplinary approach.
OBJECTIVE
To reduce the complications associated with placenta percreta (PP) by adequate preoperative planning with a multidisciplinary team. PP is a rare and potentially morbid condition of pregnancy, particularly if the urinary tract is involved. Cesarean delivery and hysterectomy are typically required to reduce the pelvic hemorrhage, placing the urinary tract at risk.


METHODS
We reviewed our urologic consultations and experience with PP in the past year. Maternal factors, surgical timing, blood loss, surgical complications, and outcomes were recorded. The timing of the urologic assessment was divided into preoperative and perioperative.


RESULTS
Five cases of PP were available. Of the 5 cases, 4 had been successfully diagnosed by prenatal ultrasonography, with 2 also requiring magnetic resonance imaging. All patients underwent cesarean delivery and hysterectomy, with significant blood loss (median 12 U transfused). A preoperative urologic assessment was done in 2 of the 5 patients, with no urinary complications found in this group. Both patients had undergone cystoscopy with placement of temporary ureteral catheters, even though the cases were emergent. In contrast, 3 patients underwent urologic consultation during or immediately after surgery. All 3 had bladder injuries, with 1 ureteral injury and delayed convalescence in this group of patients.


CONCLUSIONS
PP remains a technically challenging and high-risk obstetric condition. In the setting of urinary tract involvement, adequate imaging, surgical planning, and preoperative urologic assessment with placement of temporary ureteral catheters were associated with a lower incidence of urologic complications in our series. Adequate preoperative planning with a multidisciplinary team is recommended to reduce the complications associated with PP.
Ng
Michael K
MK
Urology Unit, Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.
Jack
Gregory S
GS
Bolton
Damien Michael
DM
Lawrentschuk
Nathan
N
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D010348:Patient Care Team; D010921:Placenta Accreta / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014570:Urologic Diseases / Q000150:complications*