Intraoperative ultrasound assessment of ureteral patency during pelvic surgery

Ureteral injuries probably represent the most feared complication of benign hysterectomies. Lack of proper intraoperative detection causes diagnostic delay, which results in additional hospitalization, prolonged catheterization, and multiple additional procedures. However, the policy of universal cystoscopy is still under debate, owing to costs, increased operative time, lack of proper training, and risk of trauma. Intraoperative ultrasound assessment can offer a valid alternative for evaluating ureteral patency. After intravenous administration of 300 ml of saline solution and 10 mg of furosemide, the bladder is filled with 300 ml of saline solution. Transabdominal ultrasound bladder scans are obtained with a convex 3.5-MHz probe in transverse planes. The power Doppler field size is set to include the entire posterior wall of the bladder, at the level of the ureterovesical junctions. Ureteral patency test is considered normal if jets are present on both sides. It is considered abnormal when either absent or comparatively diminished on one side. It is considered nondiagnostic when neither side is visualized. Cystoscopy should be performed in the case of abnormal or nondiagnostic sonographic findings. Intraoperative transabdominal power Doppler ultrasound represents a feasible, non-invasive, and inexpensive diagnostic tool for assessing ureteral patency during gynecological surgery.