title: Report of case: Partial ureteral obstruction masked by diuretics during intraoperative cystoscopy.
abstract: Injury to the lower urinary tract is a potential complication in all major vaginal and urogynecologic surgical procedures. Several authors have recommended the routine use of intraoperative cystoscopy during urogynecologic procedures. To evaluate possible injury to the lower urinary tract during intraoperative cystoscopy, the concomitant use of diuretics with indigo carmine dye has been advocated; efflux of dye is hypothesized to indicate functional patency of the urinary tract. This report describes a case in which a partial ureteral obstruction was present at the time of intraoperative cystoscopy--despite the observation of diuresis caused by furosemide. This case indicates that the efflux of indigo carmine-stained urine from both ureteral orifices is not conclusive evidence of the absence of ureteral insult during intraoperative cystoscopy.
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pennsylvania, Philadelphia, USA. jnovi@ohiohealth.com
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Novi
authors.forename: Beth H K
authors.initials: BH
authors.lastname: Mulvihill
mesh_terms: D000368:Aged; D004396:Coloring Agents; D003558:Cystoscopy; D003951:Diagnostic Errors; D004232:Diuretics; D005260:Female; D005665:Furosemide; D006801:Humans; D007203:Indigo Carmine; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014517:Ureteral Obstruction / Q000175:diagnosis* / Q000209:etiology
chemical_list: D004396:Coloring Agents; D004232:Diuretics; D005665:Furosemide; D007203:Indigo Carmine