The Effect of Patient Positioning on Ureteral Efflux During Intraoperative Cystoscopy: A Randomized Controlled Trial

Abstract

To identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy. Randomized controlled trial. Academic tertiary care medical center. A total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to intervention (n=45) or control (n=46). Exclusion criteria included known kidney disease or urinary tract anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury. Subjects in the control group were placed in a 0° supine position during cystoscopy. Subjects in the intervention group were placed in a 20° angle in reverse Trendelenburg (RT) during cystoscopy. The primary outcome, time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p=.2), nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p=.39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with longer confirmation time (>120 seconds). Reverse Trendelenburg position does not change time to confirmation of bilateral ureteral patency compared to supine position. However, there may be a benefit in position change if time to confirmation is >120 seconds. 'Ureteral Jets and Patient Positioning Study', NCT04732403, Feb 1, 2021, clinicaltrials.gov/ct2/show/NCT04732403, https://data.mendeley.com/datasets/pssg5tf4ws.