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Urethral stricture with corpora cavernosa and venous intravasation

Case contributed by Dr Mohammad Taghi Niknejad


Poor urinary stream. Long standing urethritis.

Patient Data

Age: 70 years
Gender: Male

Retrograde urethrogram reveals a long segment irregular stricture involving the proximal penile and distal bulbar urethra. The posterior urethra appear normal.  Some of the contrast has intravasated into the corpora cavernosa while some of it has entered draining veins. Contrast has also begun to fill the bladder. 

Case Discussion

Venous intravasation in retrograde urethrography is associated with pre-existing mucosal breaches in inflammatory strictures when contrast enters submucosal venous plexus and intravasation along the venous pathway. Intravasation is partly due to the degree of pressure applied during contrast administration -- the higher the pressure, the more likely intravasation will occur.

It should reminded that iodinated contrast into the venous circulation may lead to an allergic reaction in susceptible individuals (up to and including anaphylaxis). Consider stopping the procedure when encountering intravasation.

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