Comparison of Times to Ureteral Efflux after Administration of Sodium Fluorescein and Phenazopyridine.
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.



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.



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).



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.
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.
Seth A
SA
Cohen
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.
Zaid
Z
Chaudhry
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.
Janine L
JL
Oliver
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.
Evgeniy I
EI
Kreydin
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.
My-Linh T
MT
Nguyen
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.
Steven A
SA
Mills
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.
A Lenore
AL
Ackerman
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.
Ja-Hong
JH
Kim
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.
Christopher M
CM
Tarnay
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.
Shlomo
S
Raz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy / Q000379:methods; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005456:Fluorescent Dyes / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D010621:Phenazopyridine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D014513:Ureter / Q000503:physiopathology / Q000601:surgery*; D062885:Urinary Catheters
D005456:Fluorescent Dyes; D010621:Phenazopyridine; D019793:Fluorescein
fluorescein; phenazopyridine; reconstructive surgical procedures; ureter; urination