Overactive Bladder Syndrome Following Cesar ean Hysterectomy for Placenta Accreta Spectrum, A Cohort Study

The increasing incidence of placenta accreta spectrum (PAS) has emerged as a significant concern in obstetrics. This cohort study is aimed at assessing the overactive bladder and other lower urinary tract symptoms (LUTS) in women who underwent cesarean hysterectomy for PAS.

Between 2022 and 2023, a total of 84 consecutive patients with pathologically confirmed diagnosis of PAS at our academic hospital, Mashhad, Iran, were enrolled and compared with a control group of 42 women who had cesarean section (CS) without hysterectomy, matched for age, gravidity, and number of prior CSs. Symptoms were evaluated using a questionnaire 6-30 months postoperatively.

The median age of the cohort was 35 years (interquartile range, 31-38). In the cesarean hysterectomy group, cystotomy occurred in 17 (20.2%), ureteral injury in 5 (6.0%), and bladder fistula in 1 (1.2%), whereas none was observed in the cesarean group. In women who underwent cesarean hysterectomy, urinary urgency was the most prevalent symptom (48.8%), with the highest frequency and bother scores. Comparing patients who had cesarean hysterectomy with those in the control group, the urinary frequency was significantly more prevalent (34.5% vs 14.3%; p = 0.02), with higher frequency and bother scores (p = 0.017 and 0.005, respectively). Subgroup analysis within the cesarean hysterectomy group revealed that urinary frequency was significantly more prevalent in women who had placenta accreta with bladder invasion and experienced cystotomy compared to those without urinary tract injuries (p = 0.03).

Approximately half of patients undergoing cesarean hysterectomy for PAS experienced symptoms suggestive of overactive bladder 6-30 months postoperatively.