Prevalence and Factors Associated With Urologic Injury in Patients With Placenta Accreta Spectrum Undergoing Cesarean Hysterectomy Over a 10‐Year Retrospective Cohort at a Tertiary Referral Center in Shiraz, Iran

Background and Aim This study assessed the prevalence, patterns, and risk factors of urologic injuries in patients with placenta accreta spectrum (PAS) undergoing cesarean hysterectomy, aiming to help clinicians identify high‐risk cases and optimize surgical planning. Methods In this retrospective cohort study with a 6‐month postoperative follow‐up, patients with a diagnosis of PAS referred to Namazi Hospital for treatment between January 2015 and December 2024. These patients were monitored for 6 months after their cesarean section for long‐term urologic complications, and their demographic information, obstetric history, hospitalization course, and operation detail were collected. Results A total of 115 patients (23.09%) had urologic injuries during cesarean section hysterectomy. Severe intraoperative blood loss (≥ 3000 mL), as a marker of surgical complexity, was strongly associated with urologic injury (adjusted OR 7.10, 95% CI 3.73–13.53; p < 0.001). Regarding pathology, placenta accreta was associated with a significantly lower risk of urologic injury compared with placenta percreta (adjusted OR 0.52, 95% CI 0.29–0.93; p = 0.03), whereas placenta increta was not significantly associated (adjusted OR 0.90, 95% CI 0.50–1.60; p = 0.71). Conclusion Approximately one‐fifth of pregnant women with PAS undergoing cesarean hysterectomy develop urologic injuries. This emphasizes on having a multidisciplinary team of surgeons with adequate experience in the field of abnormal placental tissue involvement. Besides, efforts should be taken preoperatively with the use of sufficient diagnostic means to optimize the surgical planning and management to reduce the amount of blood loss and prevent surgical morbidities such as urologic damage.