Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates

Abstract

BACKGROUND: Intravenous indigo carmine has routinely been used to confirm ureteral patency after urogynecologic surgery. Recent discontinuation of the dye has altered clinical practice. In the absence of indigo carmine, we have used 10% dextrose in sterile water (D10) as cystoscopic fluid to evaluate ureteral patency. Glucosuria has been associated with urinary tract infection (UTI) in vivo and significantly enhanced bacterial growth in vitro. The concern is that the use of D10 would mimic a state of glucosuria albeit transient and increase the risk of postoperative UTI. OBJECTIVES: The objectives of this study were to compare the rates of postoperative UTI and lower urinary tract (LUT) injuries between patients who underwent instillation of D10 vs normal saline at the time of intraoperative cystoscopy after urogynecological surgery. STUDY DESIGN: This was a retrospective cohort study of all women who underwent cystoscopic evaluation of ureteral patency at the time of urogynecological surgery from May through December 2014 at a tertiary care referral center. We compared patients who received D10 cystoscopy fluid vs those who used normal saline. Outcomes included UTI and diagnosis of ureteral or LUT injuries. UTI was diagnosed according to Centers for Disease Control and Prevention guidelines by symptoms alone, urine dipstick, urinalysis, or urine culture. Descriptive statistics compared

Risk of Urinary Tract Infection Symptoms after Posthysterectomy Cystoscopy with 50% Dextrose as Compared with Saline Cystoscopy with Indigo Carmine

“…Despite these advantages in visualization, some practitioners have postulated that dextrose instillation may increase the risk of urinary tract infection (UTI) by providing an environment that promotes bacterial proliferation. A study by Siff et al [10] of women having dextrose compared with normal saline cystoscopy at the time of urogynecologic surgery demonstrated a 3.4-fold increased odds of UTI in the 10% dextrose group; however, the patients in this study had other risk factors for UTI including older age, postmenopausal status, and treatment condition (pelvic organ prolapse and incontinence). By contrast, a 2017 randomized control trial comparing surgeon satisfaction with 4 methods of evaluating ureteral patency found no difference in UTI symptoms between mannitol cystoscopy and other methods; they also found that mannitol bladder distention was the most satisfactory cystoscopy method [11].…”

“…If a culture was done, a positive urine culture was defined by >100 000 microorganisms/mL with no more than 2 species present. This definition was based on the Centers for Disease Control and Prevention guidelines for UTI [12] and was also used in the previously mentioned Siff et al [10] study. No urinalyses were sent and thus could not be included in our definition of UTI.…”

Different Techniques for Evaluation of Urologic Complication during Laparoscopic Gynecologic Surgery: A Review

“…A retrospective cohort study found that postoperative rates of UTI were higher in women underwent cystoscopy with 10% Dextrose at the time of intraoperative cystoscopy than using normal saline. 7 Flushing the bladder after finishing the cystoscopy could decrease the adherence of dextrose and uroepithelium. This may lead to a decrease in the postoperative rate of UTI.…”

“…This may lead to a decrease in the postoperative rate of UTI. 7 Further study is needed to support this concept. Another disadvantage of using dextrose media is it can cause sticky equipment following use.…”

Evaluation of Ureteral Patency in Patient after Prolapse Surgery with End Stage Renal Disease: A Case Report

“…They suggested cystoscopy with intravenous dye injection and placement of ureteral catheters before and after the surgery (9). Kwon CH et al ing ureteral patency (11). In patients with end stage renal disease requiring hemodialysis evaluation of ureteral patency during reconstruction surgery plays a fundamental role since to preserve residual renal function.…”