Seth A Cohen1, Zaid Chaudhry1, Janine L Oliver1, Evgeniy I Kreydin1, My-Linh T Nguyen1, Steven A Mills1, A Lenore Ackerman1, Ja-Hong Kim1, Christopher M Tarnay1, Shlomo Raz2. 1. Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; Division of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (ZC, MLTN, CMT), University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California. 2. Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; Division of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology (ZC, MLTN, CMT), University of California-Los Angeles Medical Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California. Electronic address: sraz@mednet.ucla.edu.
Abstract
PURPOSE: There is currently a national shortage of indigo carmine. In efforts to identify the most efficient aid for visualizing ureteral efflux intraoperatively we investigated the time to excretion of phenazopyridine vs a newly identified alternative, sodium fluorescein. MATERIALS AND METHODS: We analyzed prospectively collected data on a cohort of women who underwent pelvic reconstructive surgery in 2015. Per provider preference patterns a number of patients were administered 200 mg phenazopyridine orally with a sip of water 1 hour prior to the start of operative time. Other patients were given 0.5 ml 10% sodium fluorescein intravenously in the operating room. In all cases time was measured between the administration of the agent and the visualization of color changes consistent with agent efflux in an indwelling catheter, which was placed at the start of the operation. Differences in excretion times between the groups were compared with the Wilcoxon rank sum test. RESULTS: Seven women received phenazopyridine and 5 received sodium fluorescein. Mean excretion time was significantly longer in the phenazopyridine group compared to the sodium fluorescein group (81.9 vs 5.1 minutes, p = 0.0057). Median excretion time for phenazopyridine was 70 minutes (range 59 to 127) and for sodium fluorescein it was 5 minutes (range 3 to 9). CONCLUSIONS: Sodium fluorescein is excreted significantly faster in the operating room compared to phenazopyridine. Depending on the cost of these agents at an institution, in addition to the desire to decrease operative time, this may impact practice patterns and agent selection.
PURPOSE: There is currently a national shortage of indigo carmine. In efforts to identify the most efficient aid for visualizing ureteral efflux intraoperatively we investigated the time to excretion of phenazopyridine vs a newly identified alternative, sodium fluorescein. MATERIALS AND METHODS: We analyzed prospectively collected data on a cohort of women who underwent pelvic reconstructive surgery in 2015. Per provider preference patterns a number of patients were administered 200 mg phenazopyridine orally with a sip of water 1 hour prior to the start of operative time. Other patients were given 0.5 ml 10% sodium fluorescein intravenously in the operating room. In all cases time was measured between the administration of the agent and the visualization of color changes consistent with agent efflux in an indwelling catheter, which was placed at the start of the operation. Differences in excretion times between the groups were compared with the Wilcoxon rank sum test. RESULTS: Seven women received phenazopyridine and 5 received sodium fluorescein. Mean excretion time was significantly longer in the phenazopyridine group compared to the sodium fluorescein group (81.9 vs 5.1 minutes, p = 0.0057). Median excretion time for phenazopyridine was 70 minutes (range 59 to 127) and for sodium fluorescein it was 5 minutes (range 3 to 9). CONCLUSIONS:Sodium fluorescein is excreted significantly faster in the operating room compared to phenazopyridine. Depending on the cost of these agents at an institution, in addition to the desire to decrease operative time, this may impact practice patterns and agent selection.
Authors: Elizabeth M Strom; Zaid Q Chaudhry; Rong Guo; Axeline J Maisonet; Christine H Holschneider; Cecilia K Wieslander Journal: Female Pelvic Med Reconstr Surg Date: 2019 Jul/Aug Impact factor: 2.091