# Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery

## TL;DR

Using mannitol instead of saline during bladder distension in pelvic surgery significantly reduces the risk of postoperative ureteral injuries.

## Contribution

This study demonstrates that mannitol improves intraoperative detection of ureteral kinking compared to saline.

## Key findings

- Postoperative ureteral injuries occurred in 2% of the saline group and 0.3% of the mannitol group.
- Mannitol significantly reduced the occurrence of postoperative ureteral sequelae.
- Intraoperative cystoscopy with mannitol improved diagnostic performance in detecting ureteral issues.

## Abstract

Ureteral injuries are the most feared complications of gynecological surgery and therefore intraoperative recognition is of the utmost importance. Intraoperative cystoscopy represents the diagnostics of choice to investigate ureteral patency thanks to the direct visualization of ureteral flows after administration of infusion mediums. In this study, we aimed to compare the diagnostic performance of saline versus mannitol intraoperative cystoscopy in terms of false negatives in a large cohort of patients.

We retrospectively analyzed data of patients who underwent vaginal hysterectomy and high uterosacral ligament suspension for POP. Patients were divided in two groups based on the use of saline or mannitol medium for intraoperative cystoscopy. Postoperative daily control of serum creatinine was performed until discharge, as well as urinary tract imaging, in symptomatic patients.

A total of 925 patients underwent vaginal hysterectomy followed by high USL suspension for POP. Saline and mannitol medium were used in 545 patients and 380 patients respectively. Postoperative ureteral injuries were identified in 12 patients, specifically in 2% of the saline group and in 0.3% of the mannitol group.

The use of mannitol instead of saline as a bladder distension medium was able to significantly reduce the occurrence of postoperative ureteral sequelae.