Elsevier

Urology

Volume 115, May 2018, Pages 36-38
Urology

Ambulatory, Office-based, and Geriatric Urology
Phenazopyridine: A Preoperative Way to Identify Ureteral Orifices

https://doi.org/10.1016/j.urology.2018.02.023Get rights and content

Objective

To identify difficult to see ureteral orifices (UOs), urologists need a method to stain the urine. Phenazopyridine, a urinary analgesic which discolors the urine orange, can be administered orally preoperatively. We evaluated the usefulness of phenazopyridine in identifying the UOs and optimal timing of administration.

Methods

Adult patients undergoing endoscopic procedures at the Stratton VA were prospectively enrolled. Preoperative metabolic panels were reviewed. Exclusion criteria were renal insufficiency (creatinine clearance <50 mL/min), severe hepatitis or severe liver disease, glucose-6-phosphate dehydrogenase deficiency, previous hypersensitivity to phenazopyridine, or pregnancy. In phase 1, patients undergoing office flexible cystoscopy were administered 200 mg phenazopyridine the morning of the procedure. Because of the robust orange color of the urine, phase 2 was implemented. In phase 2, patients undergoing rigid cystoscopy in the operating room took 200 mg phenazopyridine at 7 PM the night before surgery. Upon entry into the bladder, UOs were identified and urine color was graded (0 = no dye, 1 = weak, 2 = moderate, and 3 = strong). Patients were assessed postoperatively for side effects.

Results

Five patients were included in phase 1. The mean time from medication to cystoscopy was 153 minutes (range 17-304 minutes). One-third of patients had excretion of grade 3 orange urine that obscured inspection of the bladder mucosa. The study design was adjusted and we transitioned to phase 2. Twenty-three patients were enrolled in phase 2. The mean time from phenazopyridine dose to cystoscopy was 14 hours (range 13-17 hours). Seventy-three percent of patients had grade 2 efflux from the UOs.

Conclusion

Phenazopyridine can successfully identify UOs and can be administered as early as the evening before the procedure.

Section snippets

Methods

Adult patients at the Albany Stratton VA Medical Center were prospectively enrolled. All patients had a preoperative metabolic panel drawn that was reviewed to determine eligibility for the study. Exclusion criteria included renal insufficiency (creatinine clearance <50 mL/min), severe hepatitis or severe liver disease, glucose-6-phosphate dehydrogenase deficiency, previous hypersensitivity to phenazopyridine, or pregnancy. The study was approved by the internal review board.

In phase 1,

Phase 1

Twelve patients were enrolled in phase 1. Seven patients were excluded (4 forgot to take the pill, 2 cancelled their procedure, and 1 could not have cystoscopy due to urethral stricture). Of the 5 patients who qualified for this phase of the study, the mean time from medication to cystoscopy was 153 minutes (range 17-304 minutes). At the time of cystoscopy, 2 patients had grade 3 urine (Fig. 1), 2 had grade 2 and 1 had grade 0.

Phase 2

Twenty-three patients were enrolled in phase 2. One patient was

Discussion

Our study confirms that phenazopyridine successfully colors the urine orange, and as a result can aid in visualization of the UOs. When performing office flexible cystoscopy, it is difficult to drain and irrigate the bladder, and as a result, the bladder mucosa was obscured in patients enrolled in phase 1 (Fig. 1). Although we had to abandon this method, 1 takeaway from this phase of the study was that the medication can be effective in as little as 17 minutes. This is in contrast to Cohen

Conclusion

Phenazopyridine can be used to identify UOs at the time of urologic endoscopic procedures. It may be administered as early as the evening before the procedure with good effect lasting up to 18 hours. It is safe, effective, readily available, and easy to administer, and should be a tool in all urologists' armamentarium.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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