Fluroescein May be Used for Ureteral Identification

Glenn Shopper, MD

Letter to the Editor:

To the Editor:

I read with interest your recent article “Methylene Blue and the Risk of Serotonin Toxicity.” There was mention of alternative intraoperative urologic dye markers, although the suggestions involve using near infrared light (indocyanine green) or administering the marker orally (phenazopyridine and vitamin B complex).

In our institution, we have used intravenous fluorescein to visualize the ureteral meatuses and confirm ureteral patency. A dose of 100 mg of fluorescein (AK-Fluor, Akorn Inc, Lake Forest, IL) resulted in a bright yellow ureteral jet a few minutes after injection. This was easily visualized without need for ultraviolet illumination.
Fluorescein has been used to identify ureters in the obstetric literature,1 with excellent efficacy and minimal side effects. Although rare severe reactions have been reported, most adverse reactions are mild and are associated with larger fluorescein doses.2

When considering alternatives to methylene blue, readers may want to include intravenous fluorescein.

Glenn Shopper, MD
Albert Einstein Health Network
Philadelphia, PA


References

  1. Doyle PJ, Lipetskaia L, Duecy E, et al. Sodium fluorescein use during intraoperative cystoscopy. Obstet Gynecol 2015;125:548-50.
  2. Kwiterovich KA, Maguire MG, Murphy RP, et al. Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 1991;98:1139-42.