V2-07: CYSTOSCOPIC FINDINGS OF PLACENTA PERCRETA WITH BLADDER INVOLVEMENT
Placenta percreta is a rare obstetric complication that can be fatal secondary to uncontrolled hemorrhage. Urologists are often consulted late in this condition and may be unaware of its evaluation. In this video, we highlight key cystoscopic findings of placenta percreta involving the bladder.
Video clips from two multiparous women with placenta percreta invading the bladder are used to highlight cystoscopic findings of this condition: 1) Submucosally pulsating arterial vessels 2) Location of abnormal vessels predominantly in the dome and posterior wall 3) Absence of trigone involvement.
Cystoscopy with bilateral ureteral stent placement was performed in both patients just prior to cesarean delivery. In the first case, cystoscopy helped guide the extent of en-bloc partial cystectomy during subsequent hysterectomy, since separation of the uterus away from bladder is contraindicated. Estimated blood loss (EBL) was 2500cc. In the second case, cystoscopy confirmed the diagnosis of bladder invasion after MRI images failed to show bladder involvement. Hysterectomy was delayed for 2 weeks after cesarean delivery in an effort to preserve the bladder, and the patient received methotrexate in the interim. Repeat cystoscopy before the hysterectomy confirmed regression of the placental vessels, making partial cystectomy unnecessary. EBL was 300cc.
Knowledge of these cystoscopic findings can help urologists diagnose and manage placenta percreta involving the bladder.