• In the absence of Indigo Carmine we have sought safe and effective alternatives to evaluate
• 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.
•Primary Objective: to compare rates of postoperative UTI between D10 vs. normal saline (NS)
• Secondary Objective: to compare ureteral and lower urinary tract injuries between groups.
•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
• 2 signs or symptoms with no other cause
• + leuk esterase and/or nitrite
• Pyuria >10 wbc/ml
• ≥105 (voided) or ≥102 (non-voided) microorganisms/ml
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.
• 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
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.