The cost–efficiency of preoperative phenazopyridine use in ureteral jet visualization at time of cystoscopy following minimally invasive hysterectomy

Abstract

Objective: To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications. Method: This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27, 2023 and March 11, 2024, with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital. Patients were assigned to the non-phenazopyridine group or the phenazopyridine group. The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded. A cost analysis was then performed. Results: In total, 106 patients were included, with 53 patients in each group. Compared with the non-phenazopyridine group, the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet (31 s vs. 42 s, p < 0.05). However, there were no significant differences observed for visualization of the second jet, total jet time, or surgery duration. Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively. Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined. Conclusion: Routine phenazopyridine use does not significantly shorten overall cystoscopy times, but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.

Keywords

• Robotic-assisted hysterectomy
• Laparoscopic hysterectomy
• Routine cystoscopy
• Ureteral jet visualization