Sodium fluorescein use during intraoperative cystoscopy

Area of Science:

• Urology
• Surgical Visualization

Background:

• Indigotindisulfonate sodium, a standard agent for ureteral meatus identification and efflux verification during cystoscopy, became unavailable due to a U.S. FDA shortage in June 2014.
• Surgeons sought safe, cost-effective alternatives for intraoperative ureteral visualization.

Purpose of the Study:

• To evaluate sodium fluorescein as a viable alternative to indigotindisulfonate sodium for visualizing ureteral patency during intraoperative cystoscopy.

Main Methods:

• Investigated various suboptimal methods including D50 water, sterile water, methylene blue-tinged saline, phenazopyridine, and intravenous methylene blue.
• Administered 0.25-1 mL of 10% sodium fluorescein intravenously and observed ureteral jets.

Main Results:

• Intravenous injection of 10% sodium fluorescein (0.25-1.0 mL) effectively visualized ureteral jets.
• A single patient experienced transient yellowing of the sclera and palms, indicating a mild, temporary side effect.

Conclusions:

• Sodium fluorescein is a highly effective substitute for indigotindisulfonate sodium in visualizing ureteral jets during intraoperative cystoscopy.
• The agent provides comparable visualization with a favorable safety profile.