title: The urologist's role in multidisciplinary management of placenta percreta.
abstract: To evaluate urological interventions in patients with placental adhesive disorders in our collaborative experience at a tertiary referral centre.
  
  
  
  We performed a retrospective analysis of a prospectively collected data set, consisting of all women that presented with placental adhesive disorders at the Royal Women's Hospital from August 2009 to September 2013. Patients who required urological intervention were identified and perioperative details were retrieved.
  
  
  
  Of the 49 women that presented with placental adhesive disorders, 36 (73.5%) underwent urological interventions. The patients were divided into three groups: planned hysterectomy (37 patients), planned conservative management (five) and undiagnosed placenta percreta (seven). In the planned hysterectomy group, 29 patients underwent preoperative cystoscopy and ureteric catheter placement. In 10 patients (34%), the placenta partially invaded the bladder and/or ureter, requiring urological repair. In the conservative management group, four underwent preoperative cystoscopy and ureteric catheter placement, and one case required closure of a cystotomy. Of the seven patients with undiagnosed percreta, two were noted to have bladder involvement requiring repair at the time of Caesarean hysterectomy.
  
  
  
  Patients with placental adhesive disorders frequently require urological intervention to prevent or repair injury to the urinary tract. These cases are best managed in specialist centres with multidisciplinary expertise including urologists and interventional radiologists.
authors.affiliation: Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Briony L
authors.initials: BL
authors.lastname: Norris
authors.affiliation: Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Wouter
authors.initials: W
authors.lastname: Everaerts
authors.affiliation: Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: Elske
authors.initials: E
authors.lastname: Posma
authors.affiliation: Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia.|Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Declan G
authors.initials: DG
authors.lastname: Murphy
authors.affiliation: Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia.|Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Umstad
authors.affiliation: Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Costello
authors.affiliation: Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia.|Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.
authors.forename: C David
authors.initials: CD
authors.lastname: Wrede
authors.affiliation: Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Kearsley
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000379:methods*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010819:Physician's Role; D010921:Placenta Accreta / Q000503:physiopathology / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D000072178:Urologists; D055988:Uterine Artery / Q000473:pathology*
keywords: bladder injury; caesarean hysterectomy; placenta accreta; placenta increta; placenta percreta; ureteric injury