ATLANTA — Cystoscopy with intravenous indigo carmine dye is safe and accurate for detecting ureteral obstruction following vaginal surgery for pelvic organ prolapse, Arlan M. Gustilo-Ashby, M.D., said at the annual meeting of the American Urogynecologic Society.
Although the technique is commonly used for secondary prevention of ureteral injury in patients undergoing vaginal surgery, its accuracy and efficacy have not been well defined, according to Dr. Gustilo-Ashby of the Cleveland Clinic Foundation.
In a retrospective study of 700 patients who underwent vaginal surgery for anterior and/or apical prolapse from 2001 to 2004, and who also underwent intraoperative cystoscopy with intravenous indigo carmine to evaluate ureteral patency, 37 patients (5.3%) had no spillage of dye from either ureter. Three of the 37 patients had preexisting renal pathology that caused the lack of spillage, and two other patients were later found to have ureteral obstruction.
Thus, the true incidence of ureteral obstruction was 5.1%, according to Dr. Gustilo-Ashby.
The incidence of ureteral obstruction in this study was highest among those patients who underwent uterosacral ligament vaginal vault suspension (5.9%), and lowest among those who underwent distal McCall's culdoplasty (0.5%) or anterior colporrhaphy (0.4%), he noted at the meeting.
In 88% of the cases of ureteral obstruction, suture removal relieved the obstruction, and in 83% of cases, the suture removal was temporary (six patients required subsequent intervention), therefore the use of cystoscopy reduced the true ureteral injury rate in this study to 0.9%, he said.