Department of Urology, Loyola University Medical Center, Maywood, IL, USA; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, IL, USA.
Department of Urology, Loyola University Medical Center, Maywood, IL, USA.
Eur Urol Focus. 2017 Feb;3(1):89-93. doi: 10.1016/j.euf.2016.01.009. Epub 2016 Feb 5.
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.
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.
静脉（IV）造影对比剂的不良反应（ARs）范围从轻度荨麻疹到威胁生命的过敏反应。腔内对比染料常规用于泌尿道，其 AR 风险可忽略不计。我们使用了 2007 年至 2011 年加利福尼亚州和佛罗里达州的医疗保健成本和利用项目州住院患者数据库，以确定接受逆行肾盂造影、经皮肾盂造影、逆行/其他膀胱造影和回肠导管造影的患者。排除了接受 IV 对比剂进行其他放射学研究的患者后，通过入院时不存在的诊断（包括休克、过敏反应、医源性低血压、荨麻疹、血管性水肿、喉痉挛、喉头水肿和/或新诊断的对比反应）的综合终点确定 AR 对造影剂的反应。总体而言，纳入了 76174 名接受过非 IV 泌尿道成像的患者，其中 367 名（0.48%）发生了 AR。多变量分析显示，与对照组相比，下尿路（比值比 [OR]：1.8；p=0.04）或逆行肾盂造影（OR：1.6；p=0.04）或顺行肾盂造影（OR：2.0；p=0.007）接受对比剂增加了 AR 的风险。与对照组相比，在泌尿道中使用造影剂会增加 AR 的风险，尽管这种风险很低，但确实存在。
我们观察了接受放射性对比剂进行泌尿科手术的患者。尽管在泌尿道中使用造影剂可能会发生不良反应（ARs），但这些反应仅发生在少数患者（约 1/200）中。此外，我们发现对静脉造影剂的过敏不会增加患者对泌尿道内造影剂的 AR 风险。
