• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Do Prophylactic Ureteral Stents Help Prevent Genitourinary Injury During Cesarean Hysterectomy for Placenta Accreta Spectrum?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Scaglione et al. (Obstetrics & Gynecology, 2022) evaluated the association between prophylactic ureteral stent placement at the time of hysterectomy for placenta accreta spectrum and genitourinary injury

METHODS:

  • Retrospective cohort study
  • Population
    • Patients with placenta accreta spectrum who underwent hysterectomy from 2001 to 2021
  • Exposure
    • Prophylactic ureteral stent placement
  • Study design
    • Odds ratios (OR) and adjusted odds ratios (aOR) were calculated using multivariable logistic regression analyses, with control for potential confounding variables
    • Prior to 2018: Use of stents was determined on a case-by-case basis and at the discretion of the attending surgeon
    • September 2018 and later: Ureteral stents placed routinely
    • Attending surgeon subspecialties
      • General ObGyn | Minimally Invasive Gynecology | MFM | Gyn Oncology 
  • Primary outcome
    • Genitourinary injury: Composite of bladder injury, ureteral injury, or vesicovaginal fistula
  • Secondary outcomes
    • Components of the primary outcome

RESULTS:

  • 236 patients
    • Prophylactic ureteral stents used: 66%
  • Genitourinary injury occurred less frequently in the stent group
    • Stent group: 28%
    • No stent group: 51%
    • OR 0.37 (95% CI, 0.21 to 0.65)
  • This association persisted after controlling for urgency of delivery, three or more prior cesarean deliveries, and whether a gynecologic oncologist was present
    • aOR 0.27 (95% CI, 0.14 to 0.52)
  • Individual injuries also occurred less frequently in the stent group compared with the no stent group
    • Bladder injury (P=0.018)
      • Stent group: 13%
      • No stent group: 25%
    • Ureteral injury (P=0.019)
      • Stent group: 2%
      • No stent group: 9%

CONCLUSION:

  • The use of prophylactic ureteral stents during cesarean hysterectomy for placenta accreta spectrum was associated with an 80% reduction in risk for genitourinary injury vs no stent use
  • The authors state

Longer surgery due to cystoscopy and stenting is an important consideration, because it may be associated with additional morbidity and cost

One solution to this time problem may be to place stents concurrently with the start of the cesarean delivery, which we have begun to do more often

Learn More – Primary Sources:

Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Placenta Accreta Spectrum Disorder: Definitions and Management
Can First Trimester TV Ultrasound Assessment of Previous Cesarean Scar Predict Placenta Accreta Spectrum?
Does Labor Before Cesarean Section Decrease Risk of Accreta in Later Pregnancies?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site