DOES PREOPERATIVE URETERIC STENTING AFFECT THE RATE OF COMPLICATIONS OF CESAREAN HYSTERECTOMY FOR PLACENTA PERCRETA?
Ahmed El Sawaf, Abdalla Mousa, Mahmoud Shoukry ElAdawy
Department of Obstetrics & Gynecology, Cairo University – Cairo - Egypt
Department of Urology, Fayoum University – Fayoum – Egypt
Objective: To compare rate of complications of elective cesarean hysterectomy for placenta percreta between patients with preoperative ureteric stenting and those without preoperative ureteric stenting. Introduction: Placenta precreta is very challenging situation for gynecologists. It is usually diagnosed prenatally and several management options are available but the most common used management is elective cesarean hysterectomy. Yet, considerable rate of complications may happen such as life threatening hemorrhage and urinary tract injury. Several studies investigated preoperative ureteric stenting to decrease the rate of urinary tract injury. So we thought to investigate the effect of preoperative ureteric stenting on rate of ureteric and bladder injuries in cesarean hysterectomy for placenta percreta, and also its effect on other complications as blood loss. Patients and methods: Thirty Egyptian pregnant female patients were enrolled in our prospective study. All patients had placenta percreta whom were prepared for elective cesarean hysterectomy; it started in January 2012 till January 2015. They were randomized into two groups, first group included 15 patients who underwent cesarean hysterectomy without preoperative ureteric stenting, and the second group included 15 patients who underwent cesarean hysterectomy with preoperative stenting. Statistical comparison between the rate of complications in each groups was done, patient data was analyzed statistically using SAS program (SAS, 1996). Results: Statistical analysis showed that there was no significant difference between both groups in rate of ureteric injury (P value was 0.8461). And again there was no significant difference between both groups in rate of bladder injury (P value was 0.7376). This may be due to small sample size. On the other hand statistical analysis showed that there was significant difference between both groups in rate of blood loss where it was significantly lower in group 2 with preoperative stenting (P value was 0.0019). As for total operation time, longer average time was in group 2 with preoperative stenting, yet statistically, no significant difference between the two groups (P value was 0.4371). Conclusions: Preoperative ureteric stenting in elective cesarean hysterectomy for placenta percreta may be beneficial in lowering the associated risk of urinary tract injury and hemorrhage, yet it is not confirmed in our study and more studies are needed to confirm this assumption.