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Oral Poster 8
ASSESSING URETERAL PATENCY USING D10 CYSTOSCOPY FLUID: EVALUATION OF URINARY TRACT INFECTION RATES

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10% Dextrose:

• In the absence of Indigo Carmine we have sought safe and effective alternatives to evaluate

ureteral patency.

• 10% Dextrose in sterile water as cysto fluid uses viscosity differences to highlight ureteral efflux.

• Glucosuria has been associated with UTI in vivo and significantly enhanced bacterial growth in vitro.

Objectives:

•Primary Objective: to compare rates of postoperative UTI between D10 vs. normal saline (NS)

cysto solutions.

• Secondary Objective: to compare ureteral and lower urinary tract injuries between groups.

Methods:

•Retrospective cohort study

• All patients who underwent intraoperative cystoscopic evaluation of ureteral patency

at the time of urogynecologic surgery from May 2014-December 2014.

• Prior to the shortage of indigo carmine (May-July), IV indigo carmine was used in the NS group.

• Cystoscopic fluid medium was chosen based on surgeon preference.

• Patients were followed for 6 weeks postoperatively.

Diagnosis of UTI

Symptoms

• 2 signs or symptoms with no other cause

Urine Dipstick:

• + leuk esterase and/or nitrite

Urinalysis:

• Pyuria >10 wbc/ml

Culture:

• ≥105 (voided) or ≥102 (non-voided) microorganisms/ml

Patient Characteristics:

303 patients met inclusion criteria

• D10 n=113, NS n =190

• Of the NS group 98 also received IV indigo carmine (May-July 2014),

4 received IV methylene blue and 88 used NS alone.

Results:

UTI Rates

• D10 group: 47.8% (95%CI 38.3-57.4) vs. NS group:

25.9% (95%CI 19.8-32.8) p<0.001

• Adj OR 3.4 [95%CI 1.6-7.5], p=0.002

− Adjusting for differences between groups and risk factors for UTI

Urinary Tract Injury

• 3 cases of ureteral obstruction (1.0%)

− All transient ureteral kinking

• 1 cystotomy (0.3%)

• No unidentified injuries presented postop

Conclusion:

While the use of D10 cystoscopy fluid for identification of ureteral

patency may be a feasible alternative in the absence of indigo carmine,

it is associated with an increased rate of postoperative UTI compared

to normal saline.

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