Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial

Area of Science:

• Urology
• Gynecologic Surgery
• Pelvic Reconstructive Surgery

Background:

• Accurate intraoperative evaluation of ureteral patency is critical for gynecologic, urologic, and pelvic reconstructive surgeries.
• Several methods exist for assessing ureteral patency during cystoscopy.

Purpose of the Study:

• To compare surgeon satisfaction with four methods of evaluating ureteral patency during cystoscopy.
• Methods compared: oral phenazopyridine, intravenous sodium fluorescein, mannitol bladder distention, and normal saline bladder distention.

Main Methods:

• An unblinded randomized controlled trial was conducted.
• 130 subjects were randomized to one of the four methods.
• Surgeon satisfaction was the primary outcome, measured by a visual analog scale (VAS).
• Secondary outcomes included ease of use, visualization quality, and time to confidence in ureteral jet visualization.

Main Results:

• Mannitol bladder distention resulted in the highest surgeon satisfaction (median VAS 0 mm) compared to phenazopyridine (48 mm), sodium fluorescein (20 mm), and normal saline (23 mm) (P < .001).
• No significant differences were observed in surgery length, cystoscopy length, or time to surgeon confidence across the groups.
• No differences in adverse events, including urinary tract infections, were reported during the 189-day follow-up.

Conclusions:

• Mannitol bladder distention is the most satisfactory method for assessing ureteral patency during cystoscopy.
• It offers improved ease of use and visualization without negatively impacting procedure times.
• The method is safe, with no increase in adverse events observed.