Urologic morbidity associated with placenta accreta spectrum surgeries: single-center experience with a multidisciplinary team

Hadi Erfani, Bahram Salmanian, Karin A. Fox, Michael Coburn, Nazlisadat Meshinchiasl, Amir A. Shamshirsaz, Rachel Kopkin, Soumya Gogia, Kunal Patel, Josef Jackson, Max Cadena, Soroush Aalipour, Shyamsunder Sukumar, Ahmed A. Nassr, Jimmy Espinoza, Steven L. Clark, Michael A. Belfort, Alireza A. Shamshirsaz

Research output: Contribution to journalArticlepeer-review


Background: Hysterectomy for placenta accreta spectrum may be associated with urologic morbidity, including intentional or unintentional cystostomy, ureteral injury, and bladder fistula. Although previous retrospective studies have shown an association between placenta accreta spectrum and urologic morbidities, there is still a paucity of literature addressing these urologic complications. Objective: We sought to report a systematic description of such morbidity and associated factors. Study Design: This was a retrospective study of all histology-proven placenta accreta spectrum deliveries in an academic center between 2011 and 2020. Urologic morbidity was defined as the presence of at least one of the following: cystotomy, ureteral injury, or bladder fistula. Variables were reported as median (interquartile range) or number (percentage). Analyses were made using appropriate parametric and nonparametric tests. Multinomial regression analysis was performed to assess the association of adverse urologic events with the depth of placental invasion. Results: In this study, 58 of 292 patients (19.9%) experienced urologic morbidity. Patients with urologic morbidity had a higher rate of placenta percreta (compared with placenta accreta and placenta increta) than those without such injuries. Preoperative ureteral stents were placed in 54 patients (93.1%) with and 146 patients (62.4%) without urologic injury (P=.003). After adjusting for confounding variables, multinomial regression analysis revealed that the odds of having adverse urologic events was 6.5 times higher in patients with placenta percreta than in patients with placenta accreta. Conclusion: Greater depth of invasion in placenta accreta spectrum was associated with more frequent and severe adverse urologic events. Whether stent placement confers any protective benefit requires further investigation.

Original languageEnglish (US)
Pages (from-to)245.e1-245.e5
JournalAmerican journal of obstetrics and gynecology
Issue number2
StatePublished - Feb 2022
Externally publishedYes


  • center of excellence
  • complex hysterectomy
  • depth of invasion
  • morbidly adherent placenta
  • multidisciplinary management
  • placenta accreta
  • placenta accreta spectrum disorder
  • urologic complication

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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