Best Method of Evaluating the Ureters When Indigo Carmine is Not Available?
BACKGROUND AND PURPOSE:
Indigo carmine has been limited or unavailable, requiring other approaches to assess ureteral patency
Grimes et al. (AJOG, 2017) sought to determine surgeon satisfaction with 4 alternative methods of evaluating ureteral patency during cystoscopy
Unblinded randomized controlled trial (RCT)
4 treatment groups:
200 mg oral phenazopyridine
25 mg IV sodium fluorescein
mannitol bladder distention
normal saline bladder distention
Primary outcome was surgeon satisfaction with the method, assessed via a 100-mm visual analog scale
Secondary outcomes included comparing visual analog scale responses about ease of each method and visualization of ureteral jets, bladder mucosa and urethra, and operative information, including time to surgeon confidence in the ureteral jets
130 subjects were randomized
Mannitol was the method that physicians found most satisfactory (P<.001)
easiest method to use, with the best visualization of the ureteral jets, bladder mucosa, and urethra
The median (range) scores for physicians assessing ureteral patency were
48 (0-83) for phenazopyridine
20 (0-82) for 25 mg sodium fluorescein
0 (0-44) for mannitol bladder distention
23 (3-96) for normal saline bladder distention
No differences were identified between groups for the following
Surgery length, cystoscopy length
Adverse events, including UTIs, within 23 hours, and at 2 to 6-week postoperatively
Visualization of ureteral jets
The use of mannitol gave surgeons the most overall satisfaction, ease of use, and superior visualization without affecting surgery or cystoscopy times
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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