Bladder hydrodissection vs. Traditional hysterectomy in placenta accreta: a single-center controlled trial pilot study in Shiraz, Iran.

BACKGROUND

Placenta accreta is a serious condition during pregnancy often leading to cesarean hysterectomy. This study aimed to investigate a novel hysterectomy method and compare its primary outcomes and adverse effects to the traditional approach.

METHODS

This single-center controlled trial was conducted at Namazi Hospital in Shiraz. Pregnant women with placenta accreta were assigned to one of two groups: using the new method of hydrodissection of the bladder or the traditional method of cesarean hysterectomy based on their consent. Key results were investigated and compared in both groups, including operation time, blood loss, urological complications, use of blood products, length of admission in the intensive care unit (ICU), and the need for a multidisciplinary team during surgery. Data were analyzed using independent sample t-tests, Mann-Whitney U-tests, chi-square tests, Fisher's exact tests, and generalized linear models.

RESULTS

Sixty-nine patients were enrolled in the study, with 23 in the bladder hydrodissection group and 46 in the traditional method group. The bladder hydrodissection group experienced significantly lower bleeding volumes and reduced need for blood products (p < 0.001). The duration of operation was also considerably shorter in the bladder hydrodissection group (p < 0.001). ICU admission duration was not different between groups (p-value 0.15). One patient in the case group and 10 in the control group need reoperation (p-value 0.04).

CONCLUSION

Bladder hydrodissection could be the preferred technique for performing hysterectomy in cases of placenta accreta, as it is linked to fewer complications such as decreased bleeding, reduced need for additional surgery, less urologic complications, and shorter duration of the procedure.

TRIAL REGISTRATION: The trial registration number is IRCT20160130026260N3, registered at http://irct.ir , on 2022-03-08. ( https://irct.behdasht.gov.ir/trial/62290 ).