title: Extravasation of the contrast media during voiding cystourethrography in a long-term spinal cord injury patient.
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.
  
  
  METHODS
  A case report.
  
  
  METHODS
  Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand.
  
  
  METHODS
  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.
  
  
  RESULTS
  A foley catheter was retained after VCUG. AD was resolved and urine cleared after a week of continuous bladder irrigation.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: A
authors.initials: A
authors.lastname: Kovindha
authors.forename: C
authors.initials: C
authors.lastname: Sivasomboon
authors.forename: P
authors.initials: P
authors.lastname: Ovatakanont
mesh_terms: D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000150:complications / Q000000981:diagnostic imaging*; D011859:Radiography; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D001750:Urinary Bladder, Neurogenic / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control
chemical_list: D003287:Contrast Media