Trends in the Usage of Contrast Allergy Prophylaxis for Endourologic Procedures

To characterize current practice patterns of urologists in the management of intravenous (IV) contrast allergy in the setting of endourologic procedures.

A survey was administered to all members of the Endourological Society to assess management of IV contrast allergy prior to ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Treatment regimens, reports of adverse outcomes, and demographics of respondents were also collected. Data were analyzed using chi-square tests.

The response rate was 15% (325/2100). A total of 21% and 28% of respondents reported giving prophylaxis prior to URS and PCNL, respectively. Nearly 3% of respondents reported having observed a severe adverse reaction to intraluminal contrast in the past. Approximately half reported giving prophylaxis only 1 hour prior to the procedure. Most respondents (77%) completed a fellowship, the most common being endourology. Chi-square analysis revealed a significant difference between giving prophylaxis for URS or PCNL and the respective case volumes (for URS, X² = 8.3, P= .004; for PCNL, X² = 8.5, P= .003) where urologists with the lowest and highest case volumes were more likely to give prophylaxis (Fig. 1). There was no significant difference between giving prophylaxis for URS or PCNL and recency of residency, fellowship training, practice setting, or practice type.

Most urologists do not give prophylaxis for patients with IV contrast allergy prior to URS and PCNL. Further studies are needed to evaluate the necessity of prophylaxis as well as to establish clear guidelines.