Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
Milano-Bicocca University, Via G.B. Pergolesi 33, 20900, Monza, Italy.
Int Urogynecol J. 2024 Mar;35(3):689-694. doi: 10.1007/s00192-024-05745-z. Epub 2024 Feb 23.
Ureteral injuries are the most feared complications of gynecological surgery and therefore intraoperative recognition is of the utmost importance. Intraoperative cystoscopy represents the diagnostics of choice to investigate ureteral patency thanks to the direct visualization of ureteral flows after administration of infusion mediums. In this study, we aimed to compare the diagnostic performance of saline versus mannitol intraoperative cystoscopy in terms of false negatives in a large cohort of patients.
We retrospectively analyzed data of patients who underwent vaginal hysterectomy and high uterosacral ligament suspension for POP. Patients were divided in two groups based on the use of saline or mannitol medium for intraoperative cystoscopy. Postoperative daily control of serum creatinine was performed until discharge, as well as urinary tract imaging, in symptomatic patients.
A total of 925 patients underwent vaginal hysterectomy followed by high USL suspension for POP. Saline and mannitol medium were used in 545 patients and 380 patients respectively. Postoperative ureteral injuries were identified in 12 patients, specifically in 2% of the saline group and in 0.3% of the mannitol group.
The use of mannitol instead of saline as a bladder distension medium was able to significantly reduce the occurrence of postoperative ureteral sequelae.
输尿管损伤是妇科手术最可怕的并发症，因此术中识别至关重要。术中膀胱镜检查代表了选择的诊断方法，可以通过在输注介质后直接观察输尿管流动来研究输尿管通畅性。在这项研究中，我们旨在比较在大量患者中，盐水与甘露醇术中膀胱镜检查在假阴性方面的诊断性能。
我们回顾性分析了因 POP 而行阴道子宫切除术和高子宫骶韧带悬吊术的患者数据。根据术中膀胱镜检查中使用盐水或甘露醇介质，将患者分为两组。术后每天监测血清肌酐直至出院，并对有症状的患者进行尿路成像。
共有 925 例患者接受阴道子宫切除术和 POP 的高 USL 悬吊术。分别有 545 例和 380 例患者使用盐水和甘露醇介质。术后发现 12 例输尿管损伤，具体来说，在盐水组中占 2%，在甘露醇组中占 0.3%。
使用甘露醇代替盐水作为膀胱扩张介质可显著减少术后输尿管后遗症的发生。
