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OBJECTIVE: Intra-urinary iodinated contrast agents are commonly used in urological procedures, but research of allergic reactions is rare. This study presents a rare case of an intra-urinary contrast reaction, followed by a comprehensive literature review of adverse reactions to intra-urinary contrast. METHODS: PubMed and Embase databases were searched using Medical Subject Headings terms related to urinary procedures and contrast reactions, with additional articles identified through reference reviews. RESULTS: Adverse reactions to intra-urinary contrast agents are rare, with most reactions being mild. Severe reactions were infrequent, and both patient-related and contrast-related factors were identified as influencing the likelihood of adverse events. However, the role of previous intravenous contrast reactions as a predisposing factor and the effectiveness of premedication in preventing these reactions remain uncertain. Furthermore, clinical guidelines for diagnosing and managing such reactions are lacking. CONCLUSION: Although urinary contrast reactions are uncommon, they can range from mild to severe, including anaphylaxis. Further research is needed to establish standardized premedication protocols and management strategies, and a better understanding of predisposing factors could enhance patient safety in urological procedures involving contrast agents.