While urinary symptoms have a significant impact on patients’ quality of life, they are underdiagnosed and remain undertreated, especially in women. To date, there has been no research on the risk of LUTS following cesarean hysterectomy for placenta accreta. The higher prevalence of CS deliveries and PAS in developing countries, provides an opportunity to assess the complication of cesarean hysterectomy for PAS more specifically. The increasing incidence of placenta accreta spectrum (PAS) has emerged as a significant concern in obstetrics. This cohort study aims to assess the overactive bladder and other lower urinary tract symptoms (LUTS) in women who underwent cesarean hysterectomy for PAS.

Between 2022 and 2023, 84 consecutive patients with pathologically confirmed diagnosis of PAS at our academic hospital, Mashhad, Iran were enrolled and compared to a control group of 42 women who had cesarean section (CS) without hysterectomy, matched for age, gravidity, and number of prior CSs. Symptoms were evaluated using a questionnaire 6-30 months postoperatively.

The median age of the cohort was 35 years (interquartile range [IQR], 31-38). In the cesarean hysterectomy group, cystotomy occurred in 17 (20.2%), ureteral injury in 5 (6.0%), and bladder fistula in one (1.2%), while none observed in the cesarean group. In women who underwent cesarean hysterectomy, urgency was the most prevalent symptom (48.8%) with the highest frequency and bother scores. Comparing patients who had cesarean hysterectomy to the control group, the urinary frequency was significantly more prevalent (34.5% vs. 14.3%; p=0.02) with a higher frequency and bother scores (p=0.017 and 0.005, respectively). Subgroup analysis within the cesarean hysterectomy group revealed that urinary frequency was significantly more prevalent in women who had placenta percreta with bladder invasion and experienced cystotomy, compared to others (p=0.03).

Approximately half of patients undergoing cesarean hysterectomy for PAS experienced symptoms suggestive of overactive bladder symptoms, likely attributable to urinary tract injury.

Approximately half of patients undergoing cesarean hysterectomy for PAS experienced symptoms suggestive of overactive bladder 6-30 months postoperatively.