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Randomized Controlled Trial
. 2023 Feb 21;9(2):449-458.
doi: 10.3390/tomography9020037.

India Ink Tattooing of Ureteroenteric Anastomoses

Mei N E Tuong  1 , Grace E Prillaman  2 , Stephen H Culp  1 , Marc Nelson  3 , Tracey L Krupski  1 , Sumit Isharwal  1
Affiliations
Randomized Controlled Trial

India Ink Tattooing of Ureteroenteric Anastomoses

Mei N E Tuong et al. Tomography. .

Abstract

While upper tract access through the insensate conduit following urinary diversion takes less time and incurs fewer costs than percutaneous kidney access does for the treatment of ureter and kidney pathology, endoscopic ureteroenteric anastomoses (UEA) identification can be difficult. We injected India Ink into the bowel mucosa near the UEA during ileal conduit diversion (IC) to determine the safety and feasibility of ink tattooing. Patients undergoing IC were prospectively randomized to receive ink or normal saline (NS) injections. The injections were placed 1 cm from UEA in a triangular configuration, and loopogram exams and looposcopy were performed to identify reflux (UR), UEA, the tattooing site and strictures in 10 and 11 patients randomized with respect to ink and NS injections, respectively. Ink patients were older (72 vs. 61 years old, p = 0.04) and had a higher Charlson Comorbidity Index (5 vs. 2, p = 0.01). Looposcopy was performed in three ink and four NS patients. Visualization of UEA was achieved in 100% of the ink and 75% of the NS patients (p = 0.26). The ink ureteroenteric anastomotic stricture (UEAS) rate was higher (N = 3 vs. N = 1) and six patients vs. one patients underwent surgery, respectively, for UEAS (p = 0.31). The study was halted early due to safety concerns. Our pilot study demonstrates that ink can be well visualized following injection near UEA during IC. However, the ink cohort had more UEAS than previously cited in the literature and our prior institutional UEAS rate of 6%. While this study sample is small, the higher incidence of UEAS after ink injection led us to question the utility and safety of ink injection following IC.

Keywords: India Ink; post-anastomotic imaging; ureteroenteric anastomosis; ureteroenteric anastomotic strictures; urinary diversion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Outcomes of loopogram and looposcopy after India Ink or normal saline injection. Data are presented as number of patients unless stated otherwise. India Ink, Ink; Ureteroenteric Anastomoses, UEA.
Figure 2
Figure 2
Image of India Ink tattoo at ureteroenteric anastomoses site. Arrows indicate ink tattoos.
See this image and copyright information in PMC

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