Urinary Incontinence and Sexual Function After Cesarean Hysterectomy due to Placenta Accreta Spectrum: A Prospective Observational Study

Background: Cesarean hysterectomy is a common approach to managing placenta accreta spectrum (PAS); however, the morbidities related to cesarean hysterectomy are not yet fully understood. This study aimed to investigate urinary incontinence (UI) symptoms and sexual function in patients who underwent hysterectomy due to PAS. Methods: This prospective cohort study was conducted at Basaksehir Cam and Sakura City Hospital in Istanbul, Turkey. The study group included 51 patients who had a cesarean hysterectomy due to PAS and 51 patients in the control group who underwent a cesarean section (CS) at term. Patients in both groups were evaluated 6 to 12 months after surgery. The patients completed the International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) for UI symptoms and the Female Sexual Function Index (FSFI). The PAS group was further divided into patients with and without bladder invasion of the placenta. Results: The ICIQ-FLUTS total score, as well as the filling, voiding, and incontinence subdomain scores, and post-void residual urine volume, were statistically significantly higher in the PAS group than in the control group (p < 0.05). The FSFI total score and the subdomain scores for arousal, lubrication, orgasm, satisfaction, and pain were statistically significantly lower in the PAS group than in the control group (p < 0.05). Subgroup analysis of the PAS group showed no statistically significant difference in UI and sexual function between hysterectomized patients with and without placental invasion of the bladder. Conclusions: Patients with PAS who undergo cesarean hysterectomy have a higher incidence of UI and impaired sexual function postoperatively compared to patients who undergo ordinary CS, regardless of bladder invasion.