Limited Diagnostic Value of Cystoscopy in the Management of Gross Hematuria Due to Placenta Percreta: A Case Report

Placenta percreta is the most severe form of abnormal placental invasion and is associated with significant maternal morbidity and mortality. Although bladder invasion may occur, gross hematuria is an uncommon and diagnostically challenging presentation. We report the case of a 35-year-old woman with a history of three prior cesarean sections who presented at 26 weeks of gestation with abdominal pain, spotting, acute urinary retention, and gross hematuria. Imaging suggested placenta previa with suspected placenta increta/percreta. Emergency cesarean delivery followed by hysterectomy was performed due to massive hemorrhage. Despite hysterectomy, persistent hematuria and hemodynamic instability continued. Cystoscopy revealed only nonspecific bladder wall hyperemia without an identifiable bleeding source. Definitive diagnosis and control of bleeding were achieved only after surgical re-exploration, which identified and ligated an actively bleeding intramural bladder vessel. This case highlights the limited diagnostic and therapeutic value of cystoscopy in placenta percreta-related hematuria. A normal or nonspecific cystoscopic examination should not exclude bladder invasion or delay surgical intervention in unstable patients.