Near-infrared fluorescence imaging of ureters with intravenous indocyanine green during radical cystectomy to prevent ureteroenteric anastomotic strictures

Bladder Cancer

Doshi CP, et al. Urology 2020.


OBJECTIVE: To determine whether intraoperative near-infrared fluorescence imaging (NFI) of the distal ureter using intravenous indocyanine green (ICG) could provide assessment of vascular adequacy and potentially decrease the risk of ureteroenteric anastomotic stricture (UAS).

METHODS: A retrospective chart review was performed of all patients undergoing open radical cystectomy by a single surgeon over a 2-year period. Patients were divided into ICG and non-ICG cohorts based on utilization of ICG. For the ICG group, adequacy of ureteral perfusion was based on visual inspection and the ureter was cut back proximally accordingly prior to anastomosis. Follow-up encounters were reviewed to determine development of benign UAS.

RESULTS: A total of 30 and 31 patients were in the non-ICG and ICG cohorts, respectively. There were no differences in baseline demographic and operative data including operative time. Median follow up was 23.2 months (IQR 7-29.3) in the non-ICG group compared to 15.8 months (IQR 12.2-18.1) in the ICG group. In the non-ICG cohort, 5/30 (16.7%) patients were diagnosed with UAS compared to 1/31 (3.2%) in the ICG cohort. The median time to stricture formation for non-ICG cohort was 5.7 months (IQR 3.6 - 6.6) compared to 7.5 months in the ICG cohort.

CONCLUSIONS: The use of NFI with intravenous ICG to assess ureteral vascularity prior to ureteroenteric anastomosis may reduce the risk of UAS.