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UPJ INSIGHT International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist
By: Grant Lardieri, BS*, University of Virginia School of Medicine, Charlottesville; Emmett H. Kennady, MD*, University of Virginia, Charlottesville; Clinton Yeaman, MD, MS, University of Virginia, Charlottesville; Noah Schenkman, MD, University of Virginia, Charlottesville | Posted on: 27 Jun 2023
*Co-first authors.
Lardieri G, Kennady EH, Yeaman C, Schenkman N. International iohexol shortage: alternative contrast agents and imaging procedures for the urologist. Urol Pract. 2023;10(3):270-277.
Study Need and Importance
The recent COVID-19–related international contrast shortage greatly affected the practice of urology, which relies heavily on contrasted imaging for diagnostic studies and procedures. Prior studies have described the use of alternative contrast agents, alternative imaging procedures, and contrast conservation strategies in urological care. We sought to perform a review of these studies and develop a resource to guide the practicing urologist in the setting of the current, and any future, iodinated contrast shortage.
What We Found
Older iodinated contrast agents such as ioxaglate and diatrizoate can replace iohexol for intravascular and intraluminal imaging in patients without renal impairment. Gadolinium-based agents such as Gadavist can also be used intraluminally for procedures and diagnostic imaging. Imaging and procedure alternatives include air contrast pyelography, contrast-enhanced ultrasound, voiding urosonography, and low tube voltage CT urography (see Table). Iohexol conservation strategies include contrast dose reduction and use of contrast management devices for vial splitting.
Table. Alternative Strategies for Intraluminal Contrast Use
| Procedure | Alternative procedure | Alternative contrast media |
|---|---|---|
| Retrograde urethrography | MR urethrography or ultrasound (nontrauma, when clinically appropriate) | Gadolinium-based contrast or other iodinated-based contrast media |
| Cystography/urodynamics | Urodynamics without video cystography when clinically appropriate | Gadolinium-based contrast or other iodinated-based contrast media |
| Retrograde ureteropyelography | Gadolinium-based contrast or other iodinated-based contrast media | |
| Percutaneous access of kidney | Direct visualization, ultrasound, RetroPerc | Gadolinium-based contrast, other iodinated-based contrast media, gas contrast |
| Abbreviation: MR, magnetic resonance. | ||
Limitations
The review is limited to the existing literature and was not performed systematically.
Interpretation for Patient Care
The COVID-19–related contrast shortage caused significant hardship for urological care internationally, leading to delayed contrasted imaging studies and urological procedures. This review can be used by the urologist to mitigate the lasting effects of the current shortage and to prepare in the event of a future iodinated contrast shortage.
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