Presentation Authors: Russell Stanley*, Cornelia DeRiese, Lubbock, TX
Introduction: This study evaluates oral agents used to visualize ureteral jets at the time of intraoperative cystoscopy. Agents examined by the study are oral pyridium and vitamin B riboflavin. The study looks to determine if administration of a standard oral dose of vitamin B riboflavin is a comparable oral agent to pyridium for evaluating patency of ureteral jets at the time of intraoperative cystoscopy.
Methods: A 3 arm double-blinded, randomized controlled pilot study was performed. Group 1 was administered pyridium, Group 2 was administered vitamin B riboflavin, and group 3 was administered thiamine as a placebo. The surgeons and patients were both blinded to the treatment. The agents were administered to the subjects on the morning of surgery 1 hour (+/- 15 minutes) prior to the procedure. A data sheet with a urine color scale was used intraoperatively as a grading system by the surgeons to grade the color of the urine jet and to evaluate the strength of the urine jet.
Results: The Cochran-Mantel-Haenszel for ordinal outcomes was used to compute the appropriate Chi-square test for equivalence between color intensity of the three groups. Preliminary results from the first 10 patients in the study have found comparable results for urine color intensity for both vitamin B riboflavin and pyridium and overall the results showed that both agents produced a strong urine jet with moderate color intensity in 75% of cases for vitamin B riboflavin and 80% of cases for pyridium as evaluated by the surgeons at the time of cystoscopy. Renal function influenced the results. Patients with creatinine levels greater than 0.5 were found to have bright colored urine jets 80% of the time based on surgeon evaluation with the urine color grading scale while patients with creatinine levels less than 0.5 were found to have light/no colored urine 15% of the time.
Conclusions: Vitamin B riboflavin is an appropriate comparable oral agent to pyridium for producing urine staining and evaluating the patency of ureteral jets at the time of intraoperative cystoscopy. Renal function can impact the evaluation of urine color. Patients with lower creatinine levels and higher functioning kidneys may clear the oral agents more quickly in the urine which may in some cases lessen the intensity of the urine jet and cause the urine to have a lighter color. However, patients with lower functioning kidneys as indicated by higher creatinine levels may have more concentrated urine which may cause urine jets to have brighter colored urine in some cases. One must account for renal function when using oral agents for evaluation of ureteral patency.