V4-08: India Ink Injection (Tattooing) of the Ureteric-Intestinal Anastomosis in Urinary Diversions: A Simple and Effective Technique to Aid in Subsequent Recognition in Retrograde Manipulations
Urinary diversion requiring uretero-intestinal anastomosis can be complicated by anastomotic stricture, upper tract stone formation or deterioration. Due to the altered anatomy and difficulty localizing the anastomoses within a bowel segment, upper tract surveillance for urothelial carcinomas as well as treatment of these complications can be difficult via a retrograde approach. Often, these interventions require percutaneous management. We describe a new technique of anastomotic tattooing using India Ink (an inert, colloidal suspension of carbon particles used safely for decades during colonoscopy to mark the site of concerning lesions) which can allow for easy identification of the ureteric-intestinal anastomosis and facilitate access to the upper tracts.
After IRB approval, we performed a prospective study to determine the safety and efficacy of applying India Ink tattoos at ureteric-intestinal anastomoses at the time of cystectomy. After construction of the ileal conduit (IC) and creation of the enterotomy for ureteral reimplantation, 0.5 cc aliquots of India Ink were injected submucosally in three areas approximately 1 cm from the enterotomy to create a triangulation around the anastomosis. The remainder of the anastomosis and procedure was completed per the usual method of the surgeon. Patients were monitored post-operatively and had follow-up flexible cystoscopy in the outpatient setting to evaluate for efficacy.
A total of 5 patients undergoing radical cystectomy with IC due to bladder cancer, neurogenic bladder or refractory interstitial cystitis were enrolled in the study. One patient was excluded from follow-up due to entering hospice due to advanced disease. No patients experienced any adverse events related to the tattooing, including anaphylactic reaction, abscess formation at the conduit, or anastomotic leak or breakdown. Follow-up flexible cystoscopy has demonstrated continued presence of the dye around the anastomotic site.
India Ink tattooing at the time of cystectomy is a quick, simple, effective and safe method to mark the anastomosis facilitating its identification during retrograde manipulation. Further follow-up is needed for long-term efficacy. This procedure may increase the urologist’s ability to access the upper tracts endoscopically and manage patients with stricture, urolithiasis, recurrent disease, or hydronephrosis post-operatively without having to rely on percutaneous approaches.