Case Report
Spinal Cord (2005) 43, 448–449. doi:10.1038/sj.sc.3101738 Published online 1 March 2005
Extravasation of the contrast media during voiding cystourethrography in a long-term spinal cord injury patient
A Kovindha1, C Sivasomboon2 and P Ovatakanont1
- 1Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- 2Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Correspondence: A Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Abstract
Objective:
To present complications and pitfalls in voiding cystourethrography (VCUG) and introduce a guideline for performing VCUG in a long-term spinal cord injury (SCI) patient with neurogenic bladder dysfunction (NBD) and contracted bladder.
Study design:
A case report.
Setting:
Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand.
Method:
We describe a chronic C5 tetraplegic man with NBD and contracted bladder, who developed autonomic dysreflexia (AD), gross hematuria and extravasation of contrast median during VCUG.
Result:
A foley catheter was retained after VCUG. AD was resolved and urine cleared after a week of continuous bladder irrigation.
Conclusion:
VCUG should be performed with caution in a long-term SCI patient with NBD and contracted bladder. Forceful pushing of the contrast media by the hand-injection method caused abrupt distention of the contracted bladder, damaged bladder mucosa and aggrevated AD. We suggest a guideline as follows: report bladder capacity and AD, if present, in an X-ray requisition form; use the gravity-drip method, stop the drip and drain the contrast media if a sudden headache and rising of blood pressure (BP) develop; observe urine colour, and report if bleeding or AD occurs.
Keywords:
spinal cord injury, neurogenic bladder dysfunction, voiding cystourethrography, autonomic dysreflexia, extravasation of contrast media
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