Use of 50% Dextrose as the Distension Medium During Cystoscopy for Visualization of Ureteric Jets

Narasimhulu, Deepa Maheswari; Prabakar, Cheruba; Tang, Nancy; Bral, Pedram

doi:10.1097/aog.0000000000001182

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…Results showed no apparent significant differences in UTI symptoms after adjusting risk factors such as BMI, diabetes, age, and day of catheter removal [ 22 ]. In addition, the risk of hyperglycemia in diabetic patients seems to be low as the medium is placed for a short amount of time in the bladder, determining negligible systemic side effects and absorption [ 23 ]. Despite these results, postoperative UTIs are still considered a side effect of dextrose cystoscopy in high-risk patients and therefore it is not considered the first option in cystoscopy procedures.…”

Section: Discussionmentioning

confidence: 99%

Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery

Barba,

Cola,

Costa

et al. 2024

Int Urogynecol J

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Introduction and Hypothesis Ureteral injuries are the most feared complications of gynecological surgery and therefore intraoperative recognition is of the utmost importance. Intraoperative cystoscopy represents the diagnostics of choice to investigate ureteral patency thanks to the direct visualization of ureteral flows after administration of infusion mediums. In this study, we aimed to compare the diagnostic performance of saline versus mannitol intraoperative cystoscopy in terms of false negatives in a large cohort of patients. Methods We retrospectively analyzed data of patients who underwent vaginal hysterectomy and high uterosacral ligament suspension for POP. Patients were divided in two groups based on the use of saline or mannitol medium for intraoperative cystoscopy. Postoperative daily control of serum creatinine was performed until discharge, as well as urinary tract imaging, in symptomatic patients. Results A total of 925 patients underwent vaginal hysterectomy followed by high USL suspension for POP. Saline and mannitol medium were used in 545 patients and 380 patients respectively. Postoperative ureteral injuries were identified in 12 patients, specifically in 2% of the saline group and in 0.3% of the mannitol group. Conclusions The use of mannitol instead of saline as a bladder distension medium was able to significantly reduce the occurrence of postoperative ureteral sequelae.

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Section: Discussionmentioning

confidence: 99%

Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery

Barba,

Cola,

Costa

et al. 2024

Int Urogynecol J

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“…13 Both 50% and 10% dextrose in water have been reported as suitable agents for ureteric jet visualisation, but have been shown to increase postoperative risk of urinary tract infection (UTI). [14][15][16] Interestingly, there have been no studies evaluating 5% dextrose in water (D5W) as the cystoscopy distension agent. The theoretical advantage of D5W is that a lower sugar concentration may reduce the incidence of UTI while still allowing for suitable ureteric jet visualisation, as well as its inexpensive cost at Can$ 1.48 (US$ 1.…”

Section: Introductionmentioning

confidence: 99%

“…The use of mannitol (Can$ 20 [US$ 15.77] per 500‐ml bag, 2022 market price) has shown higher surgeon satisfaction when compared with oral phenazopyridine, IV fluorescein, and normal saline (NS) for bladder distension 13 . Both 50% and 10% dextrose in water have been reported as suitable agents for ureteric jet visualisation, but have been shown to increase postoperative risk of urinary tract infection (UTI) 14–16 . Interestingly, there have been no studies evaluating 5% dextrose in water (D5W) as the cystoscopy distension agent.…”

Section: Introductionmentioning

confidence: 99%

Comparing vitamin B2 versus 5% dextrose in water for optimal ureteric jet visualisation at the time of pelvic reconstructive surgery: A randomised controlled trial

Zhao

Lovatsis

Gagnon

et al. 2023

BJOG

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Objective To compare preoperative vitamin B2 versus intraoperative cystoscopy distension using 5% dextrose in water (D5W) for ureteric jet visualisation during pelvic reconstructive surgery. Design Double‐blinded, randomised controlled trial. Setting Three tertiary hospitals in Toronto, Canada. Population Adult women undergoing pelvic reconstructive surgery. Methods Patients were randomised to receive 100 mg of vitamin B2 preoperatively versus bladder distension with D5W intraoperatively. Main outcomes The primary outcome was the rate of accurate detection of bilateral ureteric jets during cystoscopy. Secondary outcomes included the time elapsed until visualisation, use of intravenous furosemide or fluorescein to assist with visualisation, surgeon satisfaction, and positive urine culture 1 week after surgery. Results The intervention was completed by 236 patients (vitamin B2 n = 117, D5W n = 119). Preoperative characteristics were similar across groups. Accurate detection of both ureteric jets was high in both groups (vitamin B2 97.4% vs. D5W 90.8%, p = 0.051). The vitamin B2 group had significantly lower use of fluorescein rescue compared with the D5W group (3.4% vs. 11.8%, respectively, p = 0.025). Surgeon satisfaction while using vitamin B2 was significantly higher (p < 0.001). There were no significant differences in the time elapsed until visualisation, the use of furosemide, or the incidence of positive urine culture at 1 week after surgery. Conclusions Both preoperative vitamin B2 and intraoperative cystoscopy distension with D5W are highly available and inexpensive methods to detect ureteric jets with high accuracy at the time of pelvic reconstructive surgery. Vitamin B2 was shown to have lower rates of fluorescein rescue for visualisation and higher rates of surgeon satisfaction.

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Urethral Diverticulectomy

Cox¹,

Gilchrist²

2017

Complications of Female Incontinence and Pelvic Reconstructive Surgery

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Use of 50% Dextrose as the Distension Medium During Cystoscopy for Visualization of Ureteric Jets

Abstract: Fifty percent dextrose is an effective alternative to indigotindisulfonate sodium for visualization of ureteric jets during cystoscopy.

Cited by 10 publications

References 5 publications

Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery

Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery

Comparing vitamin B2 versus 5% dextrose in water for optimal ureteric jet visualisation at the time of pelvic reconstructive surgery: A randomised controlled trial

Urethral Diverticulectomy

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