Evaluation of Ureteral Jets with Transabdominal Color Doppler Sonography during Pelvic Surgery

Background: A potential complication of gynecologic surgery is ureteral injury, which if unidentified can result in significant morbidity for the patient. Intraoperative cystoscopy is currently used to screen for ureteral injury during pelvic surgery. Color Doppler sonography has previously been reported as a possible screening modality for ureteral injuries in postoperative patients. Technique: Color Doppler sonography is a minimally invasive procedure that can document ureteral jets. Ureteral jets are episodic flame shaped areas within the color Doppler range that correspond to turbulent flow as urine passes from the ureteral orifices into the bladder. An absent ureteral jet indicates absent flow of urine through the ureteral orifice suggesting ureteral injury proximal to the ureteral orifice. This technique does not require use of dyes or contrast agents for direct visualization. Experience: We present a series of twenty women where intraoperative transabdominal color Doppler sonography documented bilateral ureteral jets with cystoscopy confirming ureteral patency in all patients. Conclusion: Transabdominal color Doppler sonography is technically feasible to evaluate for ureteral jets intraoperatively. Larger studies are needed to determine whether color Doppler sonography can be used for intraoperative screening for ureteral injury.