Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum.

Objective: To evaluate the association between prophylactic ureteral stent placement at the time of hysterectomy for placenta accreta spectrum and genitourinary injury.
Methods: We conducted a retrospective cohort study of patients with placenta accreta spectrum who underwent hysterectomy at two referral centers from 2001 to 2021. The exposure was prophylactic ureteral stent placement. The primary outcome, genitourinary injury, was a composite of bladder injury, ureteral injury, or vesicovaginal fistula. Secondary outcomes included components of the primary outcome. We evaluated differences between groups using χ 2 and t test. To evaluate differences in the primary outcome, we reported odds ratios (ORs) and adjusted odds ratios (aORs) using multivariable logistic regression analyses to control for potential confounding variables. We used a Cochran-Armitage χ 2 trend test to evaluate difference in stent use and injury over time.
Results: In total, 236 patients were included. Prophylactic ureteral stents were used in 156 surgeries (66%). Overall, genitourinary injury occurred less frequently in the stent group compared with the no stent group (28% vs 51%, OR 0.37, 95% CI 0.21-0.65). This association persisted after controlling for urgency of delivery, three or more prior cesarean deliveries, and whether a gynecologic oncologist was present (aOR 0.27, 95% CI 0.14-0.52). Unintentional bladder injury occurred less frequently in the stent group compared with the no stent group (13% vs 25%, P =.018), as did ureteral injury (2% vs 9%, P =.019).
Conclusion: Prophylactic ureteral stent placement was associated with a decreased risk of genitourinary injury during hysterectomy for placenta accreta spectrum.
Competing Interests: Financial Disclosure D. Ware Branch disclosed that he received payment as a member of the UCB Women with Inflammatory Disease Advisory Board (meeting 09/12/2020); for Grand Rounds from the University of Iowa (Obstetric antiphospholipid syndrome: A tale of two patients. October 27, 2020); and for Obstetric antiphospholipid syndrome: Diagnosis, treatment, controversies from the American Society for Clinical Laboratory Service Region VIII Annual Seminar (October 20, 2020). He also disclosed the following: Swanson, Martin & Bell, medical expert consultancy, check issued 9/21/2020. Association of Idaho Rheumatologists. Obstetric antiphospholipid syndrome, December 4, 2021. Bendin Sumrall & Ladner, medical expert consultancy. Michigan Professional Insurance Exchange, medical expert consultancy. Grand Rounds, Cornell University/Hospital for Special Surgery Division of Rheumatology, Obstetric antiphospholipid syndrome: A tale of three patients, May 26, 2021. Bendin Sumrall & Ladner, medical expert consultancy. Gershon, Willoughby & Getz, medical expert consultancy. Snow, Christensen & Matineau, medical expert consultancy. Grand Rounds, University of New York, Stonybrook, November 3, 2021. Michelle P. Debbink receives salary support from the March of Dimes and American Board of Obstetrics and Gynecology as part of the Reproductive Scientist Development Program. The other authors did not report any potential conflicts of interest.
(Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)