Abstract
Objective:To evaluate the time of ureteral ejection of intravenous sodium fluorescein in the assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy (TLH).Material and Methods:Fifty-four women undergoing TLH were studied in a public teaching hospital in Culiacan, Sinaloa, Mexico. They underwent cystoscopic evaluation of ureteral patency after intravenous administration of 100 mg of sodium fluorescein. The present study analyzed the time elapsed in minutes from the intravenous administration of fluorescein to the outflow of stained urine by one or both ureteral meatus, the degree of urine staining, and the impact of body mass index (BMI) (BMI; normal, overweight, and obesity) on ejection time.Results:The overall average time elapsed to visualize the ejection of fluorescein through at least one ureteral meatus was 7.5 minutes [95% confidence interval (CI): 6.3-8.7]. There were no significant differences in the time of ureteral ejection of fluorescein taking BMI into account (p=0.579), with a mean time for normal BMI of 8.1 minutes (95% CI: 5.1-11.2), for overweight of 7.0 minutes (95% CI: 5.5-8.5), and for obesity of 7.8 minutes (95% CI: 5.3-10.3).Conclusion:Intravenously administered 10% sodium fluorescein dye is rapidly eliminated and strongly stains urine, which makes it useful for identifying ureteral patency during cystoscopy after TLH. Fluorescein excretion is not affected by patient BMI.
Highlights
After cesarean section, hysterectomy is the surgical procedure most commonly performed for benign indications
A dye that has been evaluated for urine staining is 10% sodium fluorescein, which is seen during cystoscopic evaluation, but there are no reports on the average time of ureteral ejection in patients undergoing total laparoscopic hysterectomy (TLH) [17,18]
It is administered intravenously at an adult dose of 500 mg/5 mL of 10% sodium fluorescein; the dye may take 10 to 15 seconds to appear in the choroidal and retinal vessels, this may vary depending on the site, rapidity of the injection, and state of the systemic circulation [19]
Summary
Hysterectomy is the surgical procedure most commonly performed for benign indications. Laparoscopic hysterectomy (LH) has many advantages over laparotomic hysterectomy, it has disadvantages, and there is an increased risk of complications when surgeons with little experience perform the procedure. Urinary tract injuries (bladder and ureter) are among the most common complications associated with LH [2,3,4]. The frequency of urinary tract injuries reported for total laparoscopic hysterectomy (TLH) (0.31%) is roughly similar to that reported for laparotomic hysterectomy (0.03-2.0%), with hematuria as the main sign of injury [5,6,7]. The risk of injuring both the bladder and ureter can be high during TLH, most injuries can be identified by cystoscopy [8].
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