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.