Robert H Blackwell1, Eric J Kirshenbaum2, Matthew A C Zapf3, Anai N Kothari4, Paul C Kuo4, Robert C Flanigan5, Gopal N Gupta6. 1. Department of Urology, Loyola University Medical Center, Maywood, IL, USA; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, IL, USA. Electronic address: rblackwell@lumc.edu. 2. Department of Urology, Loyola University Medical Center, Maywood, IL, USA. 3. Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA. 4. 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. 5. Department of Urology, Loyola University Medical Center, Maywood, IL, USA; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, IL, USA. 6. Department of Urology, Loyola University Medical Center, Maywood, IL, USA; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
Abstract
Adverse reactions (ARs) to intravenous (IV) radiographic contrast range from mild urticaria to life-threatening anaphylaxis. Intraluminal contrast dye is routinely used in the urinary tract with a minimal perceived risk of AR. We used the Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida from 2007 to 2011 to identify patients who received urinary tract contrast dye for retrograde pyelography, percutaneous pyelography, retrograde/other cystogram, and ileal conduitogram. After excluding patients who had received IV contrast for other radiologic studies, ARs to contrast were identified by a composite end point of diagnoses not present on admission including shock, anaphylaxis, iatrogenic hypotension, urticaria, angioedema, laryngospasm, laryngeal edema, and/or a new diagnosis of contrast reaction. Overall, 76 174 patients were included who had undergone non-IV urinary tract imaging, 367 (0.48%) of whom developed an AR. On multivariate analysis, receipt of contrast in the lower urinary tract (odds ratio [OR]: 1.8; p=0.04) or upper urinary tract by retrograde pyelography (OR: 1.6; p=0.04) or antegrade pyelography (OR: 2.0; p=0.007) increased the risk of AR compared with control patients. The use of contrast dye in the urinary tract is associated with a low, but present risk of AR. PATIENT SUMMARY: We looked at patients who underwent a urologic procedure using radiographic contrast media in the urinary tract. Although adverse reactions (ARs) may occur with the use of contrast media in the urinary tract, these reactions are experienced by a minority of patients (approximately 1 in 200). In addition, we found that an allergy to intravenous contrast does not increase a patient's risk of an AR to contrast within the urinary tract.
Adverse reactions (ARs) to intravenous (IV) radiographic contrast range from mild urticaria to life-threatening anaphylaxis. Intraluminal contrast dye is routinely used in the urinary tract with a minimal perceived risk of AR. We used the Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida from 2007 to 2011 to identify patients who received urinary tract contrast dye for retrograde pyelography, percutaneous pyelography, retrograde/other cystogram, and ileal conduitogram. After excluding patients who had received IV contrast for other radiologic studies, ARs to contrast were identified by a composite end point of diagnoses not present on admission including shock, anaphylaxis, iatrogenic hypotension, urticaria, angioedema, laryngospasm, laryngeal edema, and/or a new diagnosis of contrast reaction. Overall, 76 174 patients were included who had undergone non-IV urinary tract imaging, 367 (0.48%) of whom developed an AR. On multivariate analysis, receipt of contrast in the lower urinary tract (odds ratio [OR]: 1.8; p=0.04) or upper urinary tract by retrograde pyelography (OR: 1.6; p=0.04) or antegrade pyelography (OR: 2.0; p=0.007) increased the risk of AR compared with control patients. The use of contrast dye in the urinary tract is associated with a low, but present risk of AR. PATIENT SUMMARY: We looked at patients who underwent a urologic procedure using radiographic contrast media in the urinary tract. Although adverse reactions (ARs) may occur with the use of contrast media in the urinary tract, these reactions are experienced by a minority of patients (approximately 1 in 200). In addition, we found that an allergy to intravenous contrast does not increase a patient's risk of an AR to contrast within the urinary tract.