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Previously from the Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Pennsylvania in Philadelphia, Dr Novi is currently at Riverside Methodist Hospital in Columbus, Ohio. Dr Mulvihill is a clinical associate in the Department of Obstetrics and Gynecology at the Philadelphia College of Osteopathic Medicine in Pa.

Address correspondence to Joseph M. Novi, DO, Director of Urogynecology and Reconstructive Pelvic Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd, Ste 501, Columbus, OH 43214-3907. E-mail: jnovi{at}ohiohealth.com

Injury to the lower urinary tract is a potential complication in all major vaginal and urogynecologic surgical procedures. Several authors have recommended the routine use of intraoperative cystoscopy during urogynecologic procedures. To evaluate possible injury to the lower urinary tract during intraoperative cystoscopy, the concomitant use of diuretics with indigo carmine dye has been advocated; efflux of dye is hypothesized to indicate functional patency of the urinary tract. This report describes a case in which a partial ureteral obstruction was present at the time of intraoperative cystoscopy—despite the observation of diuresis caused by furosemide. This case indicates that the efflux of indigo carmine-stained urine from both ureteral orifices is not conclusive evidence of the absence of ureteral insult during intraoperative cystoscopy.