The Use of Dye-Less Cystoscopy in Assessing Urinary-Tract Integrity During Hysterectomy.


Objective: The goal of this research was to determine if dye can be omitted without affecting the accuracy of urinary-tract injury assessment during cystoscopy at the time of hysterectomy.

Materials and Methods: This prospective randomized study was performed at a gynecologic oncology service in a tertiary-care center from July 2018 to June 2019. All patients undergoing hysterectomy for either benign and malignant indications were included. The study focused on the routine cystoscopy given to each patient per protocol. Patients were randomized into 2 main groups: (1) dye versus (2) no-dye, and then into 4 subgroups based on the distending media that was used (water or saline). A linear, continuous visual scale was used to grade ureteral jet strength. The time to visualization of ureteral jets was documented. The primary outcome measure was the degree of agreement between 2 observers' ratings of ureteral jet strengths when urinary dye was used or when it was not used.

Results: According to Cronbach's α, the correlation between 2 observers was 85.3% agreement for the strength of the right-side ureteral jets and 85.8% for the left side ureteral jets. The difference in jet strength between the dye and no-dye groups was statistically significant for evaluation of the right-side ureter but not clinically significant. No statistical significance for assessment of ureteral jet strength was noted between water and saline distension media nor was there a difference between the groups for time until first jet visualization.

Conclusions: Cystoscopy can be performed without using dye for ureter and bladder assessment during gynecologic surgeries.

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Journal of Gynecologic Surgery