[The role of water-soluble vitamin for injection in determining ureteral patency by cystoscopy in transvaginal high uterosacral ligament suspension procedure].

Objective

To determine whether intravenous drip of water-soluble vitamin for injection can serve as an effective, reliable, economical, convenient and rapid biomarker for assessing ureteral patency during cystoscopy in patients undergoing transvaginal high uterosacral ligament suspension (TVHUS).

Methods

During transvaginal reconstructive pelvic surgery, 20 ml of water-soluble vitamin for injection was administered intravenously 10-15 minutes prior to cystoscopy following completion of high uterosacral ligament suspension, accompanied by intravenous infusion of 20 mg furosemide. The administration time, as well as the start and end times of cystoscopy, were recorded, along with the duration required for ureteral urine staining.

Results

From March 2005 to March 2025, over the past 20 years, the Fourth Medical Center, Chinese PLA General Hospital has performed a total of 1 825 TVHUS. 10 to 15 minutes before the scheduled cystoscopy during the operation, water-soluble vitamin for injection was intravenously dripped. Under the condition of ensuring the fluid balance throughout the patient's body, yellowing of urine was observed under cystoscopy in all cases, confirming the patency of ureter during the operation. In 1 808 cases (99.07%, 1 808/1 825), bilateral ureters were observed to spray urine during intraoperative cystoscopy. In 17 cases, only one ureter was observed to spray urine during intraoperative cystoscopy. Among them, 3 cases were caused by atrophy of one kidney, and the affected ureter had no spray urine. The remaining 14 cases (0.77%, 14/1 825) were considered to be caused by ureteral obstruction or distortion during the suture of the uterosacral ligament during the operation; after the uterosacral ligament suture was immediately removed and re-sutured, cystoscopy was performed again and it was found that the bilateral ureters sprayed urine smoothly.

Conclusions

Water-soluble vitamin for injection represents a safe, effective, and cost-efficient approach that enhances cystoscopic visualization of ureteral patency during TVHUS, thereby reducing the incidence of intraoperative ureteral obstruction. This method is worthy of widespread adoption.