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Published online: 2023-02-20
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The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

Furkan Çetin12, Seyhun Sucu2, Hüseyin Çağlayan Özcan2, Özge Kömürcü Karuserci2, Çağdaş Demiroğlu3, Muhammed Hanifi Bademkiran2, Emin Sevinçler2
DOI: 10.5603/GP.a2023.0012
·
Pubmed: 36929798
Affiliations
  1. Department of Obstetrics and Gynecology, Dr Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
  3. Department of Obstetrics and Gynecology, Faculty of Medicine, SANKO University, Gaziantep, Turkey

open access

Ahead of Print
ORIGINAL PAPERS Obstetrics
Published online: 2023-02-20

Abstract

Objectives: This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. Material and methods: This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. Results: The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7–49.8)], 26-fold [OR = 26.1 (95% CI, 8.17–83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94–27.1)] increase in the likelihood of placenta percreta, respectively. Conclusions: Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

Abstract

Objectives: This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. Material and methods: This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. Results: The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7–49.8)], 26-fold [OR = 26.1 (95% CI, 8.17–83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94–27.1)] increase in the likelihood of placenta percreta, respectively. Conclusions: Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

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Keywords

cesarean hysterectomy; cystoscopy; placenta accreta; placenta accreta spectrum; placenta increta; placenta percreta

About this article
Title

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2023-02-20

Page views

30

Article views/downloads

31

DOI

10.5603/GP.a2023.0012

Pubmed

36929798

Keywords

cesarean hysterectomy
cystoscopy
placenta accreta
placenta accreta spectrum
placenta increta
placenta percreta

Authors

Furkan Çetin
Seyhun Sucu
Hüseyin Çağlayan Özcan
Özge Kömürcü Karuserci
Çağdaş Demiroğlu
Muhammed Hanifi Bademkiran
Emin Sevinçler

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