الفهرس 
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Abstract
To compare the urological outcomes of two different approaches in urinary bladder dissection, lateral and classical central approaches, in placenta previa and placenta accreta spectrum cases in Minia maternity and children University hospital.All pregnant women suspected with PAS disorders antenatally are scheduled for different modalities of management either cesarean hysterectomy, leaving the placenta in situ or the conservative surgical management.
Some of those patients were subjected to classical bladder dissection approach and some of them were subjected to broad ligament bladder dissection approach and the associated complications were documented.
All patients were subjected to history taking, clinical examination, ultrasound examination and 2D color Doppler analysis.
The required blood and plasma units, operative time, laboratory investigations results and type of anesthesia were documented
A total of 111 pregnant women suspected to be PAS were recruited in our study. The median maternal age was 33 years and median gestational age was 37 weeks.
A number of 85 (76.6%) cases were subjected to classical bladder dissection approach and 26 (23.4%) cases were subjected to lateral approach.
Comparing the two groups according to bladder dissection showed no significant differences between the 2 groups regarding the general and clinical characteristics, ultrasound and Doppler findings.
The clinical significances by 2 dimensional and Doppler ultrasound were significantly different between the 2 groups of bladder dissection; suspicion of parametrium invasion was more prevalent among the lateral group cases (P=0.005), probability of AIP was higher among lateral dissection group (P=0.002) and extent of AIP was more diffuse among the lateral group cases (P=0.034).
The incidence of urinary bladder and/or ureteric injury did not differ with the type of bladder dissection; bladder/ureteric injury was a complication of 17.65% of central bladder dissection group in comparison to 7.7% in lateral bladder dissection group (P > 0.05).
Hysterectomy was done in 5.9% of central group cases and 26.9% of lateral group cases with a significant difference between the two groups (P = 0.006).
One case of each group was admitted to ICU post-operatively while 4 cases in central group had post-operative ileus in comparison to one case in lateral group with no significant difference between them.
Post-operative DVT was a complication of one patient in each group and no one had post-operative fistula with no significant difference between them.
The post-operative surgical site infection was a complication of two patients of central group and one case of lateral group while pelvic hematoma complication is evident in 2 patients of central group and one patient of lateral group with no significant difference between them.
The surgical outcomes accompanied with the caesarian section deliveries of our groups showed smooth separation of placenta from endometrium 83.5% of central group in comparison to 61.5% in lateral group, 10.6% triple p technique in central group in compassion to 11.5% in lateral group and 5.9% had hysterectomy in central group in comparison to 26.9% in lateral group with a significant difference between the two groups (P = 0.004), table 2.
Regarding the estimated blood loss and replacement; the total amount of blood loss was ranged between 500 – 4200 cc of blood with a median of 1500 cc, while the blood replacement products ranged from 0 – 7 units of packed RBCs and 0 – 3 fresh frozen plasma units, with a median of 1500 cc blood loss, table 2 and 3.
Furthermore, we categorized our participants according to the intra-operative outcomes and histopathological analysis into placenta Previa and placenta accrete; the PAS was evident in 24 cases of our patients` cohort in comparison to 87 cases were diagnosed as placenta previa.
Urinary bladder injury was higher among central group cases than lateral group (P=0.021*) and did not differ between the two groups in PAS cases.