Prophylactic ureteral stent placement for the prevention of urinary tract injuries in women with placenta accreta spectrum undergoing peripartum cesarean hysterectomy: A retrospective cohort study

Introduction This retrospective cohort study investigated whether preoperative bilateral ureteral stent placement reduces urinary system injuries in pregnant women with placenta accreta spectrum (PAS) undergoing peripartum cesarean hysterectomy. Material and Methods The sociodemographic, clinical characteristics, and laboratory results of 273 women who underwent peripartum cesarean hysterectomy due to suspected PAS during the study period were documented and compared. One hundred and twenty‐three of these did not receive preoperative urinary stent placement (Group 1), while 150 had such stents installed (Group 2). Results Red blood cell counts (4.10 ± 1.78 vs. 3.06 ± 0.96, odds ratio (OR): 0.782, 95% confidence interval (CI): 0.619–0.989; p = 0.027) and fresh frozen plasma replacement values (2.22 ± 0.63 vs. 3.22 ± 1.01, OR: 1.238, CI: 1.009–1.518; p = 0.035), operative times (120.0 [100.0–165.0] mins vs. 110.0 [80.0–120.0] mins , OR: 0.984, CI: 0.972–0.997; p = 0.012), days of hospitalization (6.34 ± 1.98 vs. 4.68 ± 1.45, OR: 0.849, CI: 0.736–0.979; p = 0.017), and urinary tract complications (14 [11.4%] vs. 5 [3.3%], OR: 8.357, CI: 1.784–39.153; p = 0.007) differed significantly between the groups. Additionally, while preoperative hemoglobin, hematocrit, and platelet counts were comparable between the groups ( p > 0.05), postoperative hemoglobin (9.61 ± 1.75 vs. 10.08 ± 1.81 gm/dl; p = 0.004) and hematocrit (28.88 ± 1.80 vs. 30.19 ± 2.30; p = 0.003) levels differed between them. In multivariable logistic regression analysis, both the number of previous cesarean sections (OR: 1.687; 95% CI: 1.079–2.636; p = 0.022) and the absence of ureteral stent placement (OR: 3.964; 95% CI: 1.199–13.107; p = 0.024) were independently associated with urinary tract injury. Conclusions This retrospective cohort study suggests that prophylactic temporary ureteral stent placement may be associated with a reduction in urinary tract injury in women with PAS undergoing peripartum cesarean hysterectomy. However, given the non‐randomized design, potential selection bias, and limited number of events, these findings should be interpreted with caution. Larger, multicenter prospective studies with appropriate adjustment for confounding variables are needed to confirm these results.