Real‐Time Bladder Perfusion Assessment Using ICG Fluorescence Imaging Enables Successful Reconstruction

Introduction We report a case where intraoperative indocyanine green (ICG) imaging was utilized to evaluate bladder perfusion, enabling successful bladder preservation and bilateral ureteral reimplantation. Case Presentation A 49‐year‐old woman underwent resection of a recurrent pelvic tumor. The tumor involved both ureters and bilateral vesical arteries, which were sacrificed during surgery. ICG fluorescence imaging demonstrated uniform bladder wall perfusion, guiding the decision to proceed with bladder preservation. Postoperatively, contrast‐enhanced CT and cystoscopy confirmed preserved bladder perfusion and mucosal integrity. The patient voided spontaneously without dysfunction. Conclusion Real‐time evaluation of bladder perfusion using ICG fluorescence enabled safe bladder preservation in a situation where major vascular supply was compromised. This technique may assist in intraoperative decision‐making during complex pelvic surgeries.