Use of Bladder Filling to Prevent Urinary System Complications in the Management of Placenta Percreta: a Randomized Prospective Study

Abstract

Introduction: The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics.

Material and methods: Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury.

Results: A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339).

Conclusions: Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.

Keywords: bladder injury; placental implantation abnormality; placenta percreta; urinary system injury.

Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1

a Ultrasonographic image of placenta percreta in a 35-week-old pregnancy. Lacunar structures are indicated by arrows. Note the thin border between uterus and bladder (pl = placenta, cx = cervix, bl = bladder);b Doppler ultrasonography image of the same patient with increased vascularity at the vesicouterine junction and lacunar structures.

Fig. 2

Intraoperative image of placenta percreta in which the bladder was filled with 300 ml saline (asterisk, arrows, and plus sign indicate the uterus, vesicouterine border and bladder, respectively).