Indigo carmine and methylene blue have been used to help identify efflux of the ureteral jets after gynecologic surgery to assess for iatrogenic ureteral injury. Currently, indigo carmine and methylene blue are commercially unavailable. Recently, sodium fluorescein has been reported as an alternative dye to assist in cystoscopy. We evaluated the use of fluorescein in comparison to indigo carmine and methylene blue.METHODS:
During 19 cystoscopies following gynecologic surgery, we measured the amount of time until visualization of the ureteral jets with and without administration of 1 cc of 10% sodium fluorescein IV. A questionnaire using a 5-point scale was completed by each surgeon regarding usage of fluorescein compared to prior usage of indigo carmine and methylene blue during cystoscopy.RESULTS:
The average time until colored ureteral jets were visualized following fluorescein administration was 4.3 minutes. Certainty of visualization of ureteral jets was improved with fluorescein (5 vs 2.8). Fluorescein was reported as being very helpful (4.6), with most physicians planning to use it in the future (4.4). Compared to both indigo carmine and methylene blue, fluorescein was preferred on a scale of 3.7 and 4.8, respectively. Reasons given for preference of fluorescein were quicker onset, better color contrast, cheaper cost, and fewer side effects.CONCLUSION:
Sodium fluorescein is an excellent agent to assist in visualizing ureteral jets during cystoscopy with quick onset and better color contrast at a cheaper cost.