Intraoperative Cystoscopic Evaluation of Ureteral Patency

Espaillat-Rijo, Luis M.; Siff, Lauren N.; Alas, Alexandriah; Chadi, Sami A.; Zimberg, Stephen; Vaish, Sneha S.; Davila, G. Willy; Barber, Matthew D.; Hurtado, Eric A.

doi:10.1097/aog.0000000000001750

Cited by 32 publications

(16 citation statements)

References 22 publications

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“…Prior studies have used either 100 or 200mg without significant evidence to support either doses. 7,8,9,10 Our results support the routine use of 200mg to improve outcomes. We also found that lower urine output intraoperatively is associated with increased efficacy of phenazopyridine.…”

Section: Commentsupporting

confidence: 64%

Effectiveness of Assessing Ureteral Patency Using Preoperative Phenazopyridine

Strom¹,

Chaudhry²,

Guo

et al. 2018

Female Pelvic Med Reconstr Surg

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Section: Commentsupporting

confidence: 64%

Effectiveness of Assessing Ureteral Patency Using Preoperative Phenazopyridine

Strom¹,

Chaudhry²,

Guo

et al. 2018

Female Pelvic Med Reconstr Surg

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“…This dose is lower than those used in recent studies. 20 Three cases of hypotension requiring medical treatment were observed. This side effect was not mentioned in a study in which this low dose was used.…”

Section: Discussionmentioning

confidence: 99%

Sodium Fluorescein for Ureteral Jet Detection: A Prospective Observational Study

Delbos

Annie-Kim

Langlais

et al. 2018

JSLS

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Background and Objectives:Laparoscopic hysterectomy poses the risk of lower urinary tract injury, and intraoperative recognition of urinary tract injury is often difficult. We sought to evaluate sodium fluorescein coloration of ureteral jets during cystoscopy after laparoscopic hysterectomy and to evaluate surgeons' satisfaction with this method of injury detection.Methods:This was an observational study, in which data were collected prospectively. A total of 30 women who underwent laparoscopic hysterectomy from August 2016 to February 2017 at the Centre Hospitalier de l'Université Laval (CHUL) de Québec. Twenty-five milligrams of 10% intravenous sodium fluorescein was administered after vaginal cuff closure. Cystoscopy was then systematically performed, and the time to visualization (time from injection to coloration of ureteral jet), the quality of coloration, and the duration of cystoscopy were recorded. Side effects were systematically recorded and rigorously analyzed.Results:Most frequent indications for hysterectomy were fibroids and endometriosis with uterine weight from 76 to 885 g. Ninety-three percent of patients (n = 28) had bilateral ureteral jet coloration, whereas 1 patient had no coloration bilaterally, and another patient had a complete unilateral obstruction immediately diagnosed and resolved intraoperatively after removal of the vaginal sutures. In 90% of cases (n = 27), surgeons were highly satisfied with the use of sodium fluorescein. The average time between visualization of both left and right ureteral jets was 1 minute. Side effects included hypotension (n = 3) and yellow coloration of urine (n = 15).Conclusion:Our study suggests that sodium fluorescein is an effective dye for documenting ureteral patency and improving visualization of ureteral jets during cystoscopy upon completion of laparoscopic hysterectomy.

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“…First, cystoscopy was not terminated in any of the cases before the surgeon and his assistants confirmed satisfactory bilateral ureter jet streams. Second, the use of saline is certainly acceptable by gynecologists and urologists and has served as the control arm in published clinical trials aiming to find alternatives to indigo carmine [19,20].…”

Section: Commentmentioning

confidence: 99%

Routine Cystoscopy during Robotic Hysterectomy for Endometrial Cancer

El-Neemany¹,

Pursell²,

Curcio³

et al. 2019

Reports Gynecol Surg

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Background: The use of routine cystoscopy after hysterectomy is controversial.Objective: To evaluate the role of routine cystoscopy in the detection of urinary tract injuries in robotic total laparoscopic hysterectomies performed for endometrial cancer staging. Study design: This was a retrospective chart review of patients undergoing robotic-assisted laparoscopic hysterectomy for endometrial cancer staging by a single gynecologic oncologist between January 2012 and December 2015. Routine cystoscopy was performed in all cases. Results: A total of 157 cases met inclusion criteria and among those, five cases of urinary tract injury were identified (3.2%). Among the patients with urinary tract injury, average age was 66 [range 47, 90] years old, the average BMI was 34 [range 25, 34], and all patients had Stage I of endometrial cancer. Three patient injuries were detected intraoperatively, and 2 injuries were diagnosed postoperatively. Two of the intraoperative injuries were caused by dissection of the bladder from the lower uterine segment and detected prior to performing the cystoscopy. Another intraoperative injury was detected immediately after performing a mini-laparotomy to extract a larger uterus. The 2 urinary tract injury cases detected postoperatively were both ureteral injuries. The visual detection rate of the urinary tract injuries was 60% (3/5), while the cystoscopy detection rate was 0%. There were no significant differences detected in risk factors between the injury cases and the whole cohort. Conclusion: In this study, the incidence of urinary tract injury in robotic hysterectomy performed for endometrial cancer staging was 3.2%. Performing routine cystoscopy did not improve detection of urinary tract injuries in these cases.

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Intraoperative Cystoscopic Evaluation of Ureteral Patency

Abstract: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02476448.

Cited by 32 publications

References 22 publications

Effectiveness of Assessing Ureteral Patency Using Preoperative Phenazopyridine

Effectiveness of Assessing Ureteral Patency Using Preoperative Phenazopyridine

Sodium Fluorescein for Ureteral Jet Detection: A Prospective Observational Study

Routine Cystoscopy during Robotic Hysterectomy for Endometrial Cancer

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