Bladder Suture in Uterus-Sparing Surgery and Hysterectomy for Placenta Percreta
NCT ID: NCT06267599
Last Updated: 2024-02-20
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
81 participants
OBSERVATIONAL
2023-09-01
2024-01-01
Brief Summary
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Detailed Description
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Conditions
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Study Design
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COHORT
RETROSPECTIVE
Study Groups
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Bladder suture group
This group consisted of patients in whom we could not open the bladder and uterine cervix by dissection, so we had to open the bladder. In this group, the bladder dome was opened and a special suture was passed through the bladder to control bleeding. This procedure was performed to control bleeding.
ACAR-Style Bladder Suture
In cases where dissection is not possible, the upper border of the bladder is opened transversely with a cutter, and the ureteral catheters and trigone inside the bladder are observed. The bladder invasion border is re-evaluated intravesically. The uterine arteries are held bilaterally with a sensitive clamp that does not crush the uterine arteries. Then, the uterus is incised from the upper border of the bladder without damaging the bladder and the predetermined myometrial invasion area is resected. After the placenta is removed, the cervical canal is found and marked with a number one vicryl suture. In these patients, the placental material is removed in pieces in the cervix area where the bladder is invaded. After the removal of the placenta, the cervix in the lower segment of the uterus is orientated and sutured together with the bladder, and this area is closed.
Control group
For the patients in this group, the vascular structures between the bladder and cervix were coagulated one by one. The bladder was not opened during this procedure.
No interventions assigned to this group
Interventions
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ACAR-Style Bladder Suture
In cases where dissection is not possible, the upper border of the bladder is opened transversely with a cutter, and the ureteral catheters and trigone inside the bladder are observed. The bladder invasion border is re-evaluated intravesically. The uterine arteries are held bilaterally with a sensitive clamp that does not crush the uterine arteries. Then, the uterus is incised from the upper border of the bladder without damaging the bladder and the predetermined myometrial invasion area is resected. After the placenta is removed, the cervical canal is found and marked with a number one vicryl suture. In these patients, the placental material is removed in pieces in the cervix area where the bladder is invaded. After the removal of the placenta, the cervix in the lower segment of the uterus is orientated and sutured together with the bladder, and this area is closed.
Eligibility Criteria
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Inclusion Criteria
* Clinical diagnosis of PAS
* PAS with bladder invasion
Exclusion Criteria
* Cases with other types of placental invasion (e.g., placenta accreta, placenta increta),
* Cases with missing key data points.
18 Years
50 Years
FEMALE
No
Sponsors
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Necmettin Erbakan University
OTHER
Responsible Party
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Cemre Alan
Fellow
Principal Investigators
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Ali Acar
Role: STUDY_DIRECTOR
MD
Şükran Doğru
Role: PRINCIPAL_INVESTIGATOR
MD
Fatih Akkuş
Role: STUDY_CHAIR
MD
Cemre Alan
Role: STUDY_CHAIR
MD
Fikriye Karanfil Yaman
Role: STUDY_CHAIR
MD
Huriye Ezveci
Role: STUDY_CHAIR
MD
Orhan Ay
Role: STUDY_CHAIR
MD
Fethiye Şahin
Role: STUDY_CHAIR
MD
Burçin Elaziz
Role: STUDY_CHAIR
MD
Meryem Gümüş
Role: STUDY_CHAIR
MD
Locations
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Cemre Alan
Konya, , Turkey (Türkiye)
Countries
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References
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Horgan R, Hessami K, Hage Diab Y, Scaglione M, D'Antonio F, Kanaan C, Erfani H, Abuhamad A, Shamshirsaz AA. Prophylactic ureteral stent placement for the prevention of genitourinary tract injury during hysterectomy for placenta accreta spectrum: systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2023 Oct;5(10):101120. doi: 10.1016/j.ajogmf.2023.101120. Epub 2023 Aug 5.
Couret M, Huang Y, Khoury-Collado F, Friedman A, Hou JY, St Clair CM, Tergas AI, Ananth CV, Wright JD. Patterns of care for women with placenta accreta spectrum. J Matern Fetal Neonatal Med. 2021 Oct;34(20):3370-3376. doi: 10.1080/14767058.2019.1684471. Epub 2019 Nov 19.
Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol. 2012 Jul;120(1):207-11. doi: 10.1097/AOG.0b013e318262e340.
Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine; Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018 Dec;219(6):B2-B16. doi: 10.1016/j.ajog.2018.09.042.
Woldu SL, Ordonez MA, Devine PC, Wright JD. Urologic considerations of placenta accreta: a contemporary tertiary care institutional experience. Urol Int. 2014;93(1):74-9. doi: 10.1159/000356064. Epub 2014 Apr 9.
Erfani H, Salmanian B, Fox KA, Coburn M, Meshinchiasl N, Shamshirsaz AA, Kopkin R, Gogia S, Patel K, Jackson J, Cadena M, Aalipour S, Sukumar S, Nassr AA, Espinoza J, Clark SL, Belfort MA, Shamshirsaz AA. Urologic morbidity associated with placenta accreta spectrum surgeries: single-center experience with a multidisciplinary team. Am J Obstet Gynecol. 2022 Feb;226(2):245.e1-245.e5. doi: 10.1016/j.ajog.2021.08.010. Epub 2021 Aug 13.
Wu WJ, Smith AD, Okeke Z. Bladder Necrosis Associated with Placenta Accreta, Embolization, and Repair of Cystotomies. J Endourol Case Rep. 2015 Oct 1;1(1):24-6. doi: 10.1089/cren.2015.29007.wjw. eCollection 2015.
Li GT, Li XF, Ding Y. Cervicovesical U-suture: An effective novel alternative to partial cystectomy for controlling life-threatening postpartum hemorrhage due to placenta accreta spectrum invading the bladder. Asian J Surg. 2022 Dec;45(12):2745-2747. doi: 10.1016/j.asjsur.2022.06.018. Epub 2022 Jun 18. No abstract available.
Acar A, Ercan F, Pekin A, Elci Atilgan A, Sayal HB, Balci O, Gorkemli H. Conservative management of placental invasion anomalies with an intracavitary suture technique. Int J Gynaecol Obstet. 2018 Nov;143(2):184-190. doi: 10.1002/ijgo.12593. Epub 2018 Aug 13.
Feng JP, Fan DZ, Lin DX, Zhang HS, Rao JM, Liu ZP. Sandwich excision in patients with placenta percreta involving maternal bladder. Eur Rev Med Pharmacol Sci. 2022 Jun;26(12):4252-4257. doi: 10.26355/eurrev_202206_29062.
Matsuzaki S, Yoshino K, Endo M, Kakigano A, Takiuchi T, Kimura T. Conservative management of placenta percreta. Int J Gynaecol Obstet. 2018 Mar;140(3):299-306. doi: 10.1002/ijgo.12411. Epub 2018 Jan 3.
Matsubara S. Intentional cystotomy in surgery for placenta percreta with bladder invasion: Not only for hysterectomy but also for uterus-preserving surgery. Acta Obstet Gynecol Scand. 2023 Jan;102(1):122-123. doi: 10.1111/aogs.14484. Epub 2022 Nov 30. No abstract available.
Scaglione MA, Allshouse AA, Canfield DR, Mclaughlin HD, Bruno AM, Hammad IA, Branch DW, Maurer KA, Dood RL, Debbink MP, Silver RM, Einerson BD. Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum. Obstet Gynecol. 2022 Nov 1;140(5):806-811. doi: 10.1097/AOG.0000000000004957. Epub 2022 Oct 5.
Matsubara S, Takahashi H, Baba Y. Handling aberrant vessels located in the posterior bladder wall in surgery for abnormally invasive placenta: a non/less-touch technique. Arch Gynecol Obstet. 2017 Nov;296(5):851-853. doi: 10.1007/s00404-017-4498-2. Epub 2017 Sep 5.
Friedrich L, Mor N, Weissmann-Brenner A, Kassif E, Friedrich SN, Weissbach T, Castel E, Levin G, Meyer R. Risk factors for bladder injury during placenta accreta spectrum surgery. Int J Gynaecol Obstet. 2023 Jun;161(3):911-919. doi: 10.1002/ijgo.14567. Epub 2022 Nov 28.
Crocetto F, Saccone G, Raffone A, Travaglino A, Gragnano E, Bada M, Barone B, Creta M, Zullo F, Imbimbo C. Urinary Incontinence after Planned Cesarean Hysterectomy for Placenta Accreta. Urol Int. 2021;105(11-12):1099-1103. doi: 10.1159/000518114. Epub 2021 Aug 18.
Related Links
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Dogru S, Akkus F, Atci AA et al. (2022) The fetal and maternal outcomes related to previous number of cesarean sections and uterus sparing surgery in women with abnormal placentation. Journal of Clinical and Investigative Surgery 7:29-30.
Doğru Ş, Altınordu Atcı A, Akkuş F et al. (2022) Use of ureteral catheter in uterine-sparing surgery for placenta accreta. Perinatal Journal 30:158-164.
Other Identifiers
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ACAR-Style Bladder Suture
Identifier Type: -
Identifier Source: org_study_id
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