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

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Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with that of 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. Then, a cost analysis was 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.

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