RCT Results: What is the Optimal Method for Ureteric Jet Visualization at the Time of Pelvic Surgery?
BACKGROUND AND PURPOSE:
There is still no consensus on the best ureteric jet visualization agent
Oral agents that alter urine color and distension fluid that can alter urine viscosity have both been used
Zhao et al. (BJOG, 2022) compared the efficacy of pre-operative vitamin B2 vs intra-operative cystoscopy distension using 5% dextrose in water (D5W)
Double-blind, randomized controlled trial
Undergoing pelvic reconstructive surgery
100 mg of vitamin vitamin B2 administered pre-operatively
Bladder distension with D5W intra-operatively
Rate of accurate detection of bilateral ureteric jets during cystoscopy
Time elapsed until visualization
Use of IV furosemide or fluorescein to assist with visualization, surgeon satisfaction
Positive urine culture one week after surgery
Vitamin B2: 117 patients | D5W: 119 patients
Accurate detection of both ureteric jets was high in both groups
Vitamin B2: 97.4%
The vitamin B2 group had significantly lower use of fluorescein rescue compared to the D5W group
Vitamin B2: 3.4%
Surgeon satisfaction with vitamin B2 was significantly higher (P<0.001)
There were no significant differences in
The time elapsed until visualization
The use of furosemide
The incidence of positive urine culture one week after surgery
For patients undergoing pelvic reconstructive surgery, both vitamin B2 and bladder distension with D5W can be used to visualize ureteric jets effectively and accurately
Vitamin B2 had lower rates of fluorescein rescue and higher rates of physician satisfaction
The authors state
As both vitamin B2 and D5W proved to be effective for ureteric jet visualisation in this group of patients undergoing female pelvic reconstructive surgery, it is quite certain that these agents would also be useful in general gynaecology, minimally invasive gynaecological surgery and gynaecological oncology patient populations when cystoscopy is required to determine ureteral patency
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