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Urine staining intensity and observation of intraoperative ureteral jets among oral agents

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Abstract

Introduction and hypothesis

To determine if administration of a standard 400 mg oral dose of riboflavin (vitamin B2) was comparable to phenazopyridine (pyridium) for evaluating ease of visualization of ureteral jets at the time of cystoscopy.

Methods

A three-arm double-blinded, randomized controlled study was performed consisting of thiamine as placebo, phenazopyridine, and riboflavin. Agents were administered the morning of surgery prior to surgical procedure. The primary outcome was the ease of visualization of the ureteral jets based on a grading of urine stain intensity on a 7-point color scale, where 1–2 were minimal yellow staining, 3–4 were moderate yellow staining, and 5–7 defined as intense yellow staining. Analysis of covariance (ANCOVA) was used with pairwise comparison to characterize urine stain intensity as a continuous variable among the three groups controlling for age, BMI, creatinine, and time from ingestion of medication to first cystoscopy.

Results

Eighty-four subjects were randomized with a mean ± SD age of 46.25 + 11.36 and BMI of 32.46 + 6.59. Riboflavin did have moderate or intense staining in 57% of cases; however, there was no significant difference between urine staining intensity compared to placebo (p = 0.21). There was a statistically significant increased urine staining intensity for phenazopyridine compared to placebo (p = 0.001) and for phenazopyridine compared to riboflavin (p = 0.001).

Conclusions

Phenazopyridine provided statistically significantly greater urine staining compared to both riboflavin and placebo and should be considered primarily for ease of ureteral jet visualization.

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Acknowledgements

The authors wish to acknowledge the contribution of the Texas Tech University Health Sciences Center Clinical Research Institute and Dr. Sam Prien for their help in conducting this study. The authors also thank Dr. Holly E. Richter for reviewing this report.

Funding

The study personnel utilized internal research funding available through the Texas Tech University Health Sciences Center in Lubbock, Texas, to purchase the study agents from the TTUHSC Pharmacy.

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Authors and Affiliations

  1. Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Bldg. 176F, Suite 10382, 619 19th Street South, Birmingham, AL, 35249, USA

    Russell Stanley

  2. Texas Tech University Health Sciences Center, Odessa, TX, USA

    Cornelia deRiese

  3. Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Mhd Hasan Almekdash

Authors
  1. Russell Stanley
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  2. Cornelia deRiese
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  3. Mhd Hasan Almekdash
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Contributions

Developed the research project, carried out key components of the day to day research, and developed and wrote the key portions of the manuscript.

Assisted with the development of the research project, assisted with carrying out key components of the day to day research, and assisted with editing the manuscript.

Performed the statistical analysis for this research project and assisted with writing the key portions of methods and results section of this manuscript.

Corresponding author

Correspondence to Russell Stanley.

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Stanley, R., deRiese, C. & Almekdash, M.H. Urine staining intensity and observation of intraoperative ureteral jets among oral agents. Int Urogynecol J 33, 2427–2433 (2022). https://doi.org/10.1007/s00192-021-04867-y

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  • DOI: https://doi.org/10.1007/s00192-021-04867-y

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