Paralysis Research Today is a free monthly online journal that collates and summarizes the latest research about Paralysis, including details on treatment, diagnosis, facial paralysis, sleep paralysis.

Extravasation of the contrast media during voiding cystourethrography in a long-term spinal cord injury patient.

Kovindha A, Sivasomboon C, Ovatakanont P

Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

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 C(5) 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.

Published 4 July 2005 in Spinal Cord, 43(7): 448-9.
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