• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Does Riboflavin Increase Ureteral Jet Visibility During Cystoscopy?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Ureteral integrity using cystoscopy
    • Is recommended by AUGS following all pelvic organ prolapse surgeries
    • Can be used to following surgeries where there may be concern regarding ureteral injury
  • The traditional method of increasing ureteral jet visibility in the past was indigo carmine, but recent procurement has been difficult
  • Stitely et al. (Obstetrics & Gynecology, 2019) assessed the efficacy of oral riboflavin to enhance visibility in the determination of ureteric patency at cystoscopy

METHODS:

  • Randomized, double blinded, clinical trial (RCT)
    • Gynecologic surgery where cystoscopy was a planned component of the procedure
    • Participants, surgeons and research team were unaware of who received intervention vs placebo  
  • Patients received orally (oral capsules night before surgery) either
    • Riboflavin 400 mg
    • Placebo
  • During cystoscopy: The surgeon visualized and video recorded the ureteric jets
  • Primary outcome: Stronger yellow color of urine seen on cystoscopy using a 3-point scale
  • Secondary outcomes included
    • Ease of ureteric jet identification (5-point scale)
    • Proportion of patients where both jets were visualized
  • Statistical analysis
    • 0.75 point mean difference in the color scale
    • 80% power and 0.05 significance level
    • Minimum sample size of 60 was required (additional patients recruited to account for potential drop out)
  • Charts reviewed post-surgery to determine of any ureteric injuries had occurred

RESULTS:

  • 66 participants were randomized | 33 in to each study group
  • Compared to placebo controls, riboflavin group had an increase in yellow urine color (P<.001)
    • Riboflavin group: Median of 2 (3-point scale)
    • Placebo: Median of 1 (3-point scale)
  • Jets were more easily visualized in the riboflavin group (P<.013)
    • Riboflavin group: Median of 5 on a 5-point scale
    • Placebo group: Median of 4 on a 5-point scale
  • There was no statistical difference between group in proportion of women who had bilateral ureteral patency confirmed (P=.71)
    • Riboflavin group: 91% 
    • Placebo group: 85%  

CONCLUSION:

  • Authors recognized that subjective measurements used in this study
  • However, strengths include RCT design
  • The authors conclude that riboflavin is a safe and inexpensive option to assess ureteric jets and “should be considered for routine use’

Learn More – Primary Sources:

Oral Riboflavin to Assess Ureteral Patency During Cystoscopy

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Which Surgeries are Most Likely to Lead to Urinary Tract Injury?
Best Method of Evaluating the Ureters When Indigo Carmine is Not Available?
Practical info for your gynecology practice
Cystourethroscopy – Did I Cut, Twist, Suture, Burn, or Make a Hole in It?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

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.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
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.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site