Design: Patients undergoing laparoscopic hysterectomy for benign indications with one of our three MIGS faculty were selected to receive or not receive phenazopyridine pre-operatively. The time to first ureteral jet visualization, interval to second jet visualization, total jet time, and surgery duration were recorded.

Setting: Large university hospital.

Patients or Participants: 106 patients.

Interventions: 53 patients received 200mg oral phenazopyridine around 1 hour prior to the OR and 53 patients did not receive any planned oral or intravenous agents prior to cystoscopy.

Measurements and Main Results: The phenazopyridine group had a significantly shorter time to visualization of the first ureteral jet (31 vs. 42 seconds, P<0.05). However, there was no significant difference observed in time to visualization of the second jet, total jet time, or surgery duration. Two patients were given an IV agent intra-operatively to assist with visualization of jets, both in the non-phenazopyridine group. No side-effects from oral or intravenous agents were documented in either group. No bladder or ureteral injuries were identified in either group.

Conclusion: Recent literature has highlighted the benefit of routine administration of pre-operative oral phenazopyridine compared to the routine administration of intra-operative intravenous agents such as sodium fluorescein or indigo carmine, primarily due to cost efficacy. Our MIGS division has historically used infusion of normal saline without a routine agent, so we intended to evaluate the possible benefit of routine phenazopyridine use. While we found no difference in cystoscopy times, total OR times, or patient outcomes between the two groups, routine phenazopyridine administration was found to be more cost effective given increased rates of IV agent use in the non-phenazopyridine group ($32.33 ($0.61 phenazopyridine x 53 patients) vs. $222 ($132 indigo carmine x1 patient + $90 methylene blue x1 patient).