Extravasation of the Contrast Material During Voiding Cystourethrography in a Chronic Spinal Cord Injury Patient: A Case Report

Ann Rehabil Med, 2017 · DOI: https://doi.org/10.5535/arm.2017.41.2.323 · Published: April 1, 2017

Spinal Cord Injury Urology Rehabilitation

Simple Explanation

This case report describes a rare complication following a voiding cystourethrography (VCUG) procedure in an adult patient with a spinal cord injury. The patient experienced extravasation, or leakage, of the contrast material used during the VCUG. VCUG is a common diagnostic test used to detect urinary tract complications in patients with neurogenic bladder, which is a frequent issue for those with spinal cord injuries. While generally considered safe, complications can occur. In this particular case, the patient's bladder ruptured during the procedure, leading to the contrast material leaking into surrounding tissues. However, the patient recovered without needing surgery or other interventions.

Study Duration

5 years

Participants

One 59-year-old female with paraplegia

Evidence Level

Case Report

Key Findings

1
The study reports a rare case of extraperitoneal bladder rupture with spontaneous healing in a spinal cord injury patient without manual instillation during VCUG.
2
Extravasation of contrast media occurred due to infusion via gravity force, not manual instillation, highlighting a potential risk even without forceful injection.
3
The patient's bladder pressure changed abruptly even with a small volume change, suggesting altered bladder compliance common in spinal cord injury patients contributed to the rupture.

Research Summary

This case report details an instance of contrast material extravasation during VCUG in a 59-year-old female with paraplegia due to tuberculous spondylitis. The extravasation occurred without manual instillation of the contrast and resolved spontaneously. The patient had a history of neurogenic bladder and was undergoing routine evaluation. The bladder rupture was extraperitoneal and managed conservatively with a urethral catheter and antibiotics. The authors emphasize the need for caution when performing VCUG in spinal cord injury patients, particularly regarding bladder capacity and instillation methods, to avoid potential complications like bladder rupture.

Practical Implications

Careful VCUG Performance

Clinicians should exercise caution during VCUG in spinal cord injury patients, particularly when assessing bladder capacity.

Gravity Method Instillation

Contrast material should be instilled using the gravity method with the container placed no higher than 60 cm above the patient’s level.

Monitor Patient Response

Physicians must stop the drip and drain the contrast media if sudden headache occurs or rising of blood pressure develops.

Study Limitations

1
Single case report limits generalizability
2
Lack of a specific formula for assessing dysfunctional bladder volume in adults
3
Reliance on imaging and clinical assessment without histopathological confirmation of bladder changes

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