Options to Evaluate Ureter Patency at Cystoscopy in a World Without Indigo Carmine

Intraoperative cystoscopy has been studied as a means to identify ureteral injuries at the time of gynecologic surgery. The majority of published studies investigating intraoperative cystoscopy have used indigo carmine to dye the urine to allow visualization of ureteral jets; unfortunately, however, this dye is currently not available in North America. The unavailability of indigo carmine may be a permanent reality that forces gynecologists to examine alternatives for the evaluation of ureteral integrity. Various alternative methods have been suggested, ranging from cystoscopy without dye to other commercially available products that dye the urine. Alternatives to cystoscopy for assessing ureteral integrity exist as well. This review provides an evidence-based review of the various methods available for evaluating ureteral patency, with specific information on dosing, adverse effects, and contraindications. This review will equip practicing gynecologists to choose an alternative method for assessing ureteral integrity that is tailored to their specific needs.