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Li JJ, Au CF. Inappropriate placement of urinary catheters into the ureter: A case report and literature review. Medicine (Baltimore) 2024; 103:e37623. [PMID: 38608084 PMCID: PMC11018196 DOI: 10.1097/md.0000000000037623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/26/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To emphasize preventive measures and outline management strategies for inadvertent ureteral cannulation. METHODS We present a case report and conduct a literature review of 39 case reports on ureteral cannulation, examining a total of 48 patients. RESULTS About 67% of the cases were female, and long-term catheterization was observed in 67% of the cases. Neurological conditions such as spinal cord injury (SCI), stroke, dementia, multiple sclerosis, and myasthenia gravis were the primary factors (48%) in ureteral cannulation. Symptoms included flank pain (46%), fever (31%), oliguria (27%), non-deflatable balloon issues (25%), hematuria (21%), abdominal pain (17%), urine leak (12.5%), and nausea/vomiting (8%). Complications varied, including acute pyelonephritis (35%), acute kidney injury (27%), urosepsis (21%), and ureter rupture (17%). Despite inadvertent catheter placement, 25% of patients had no complications. More than half of the patients (58%) were managed through catheter change, while 27% underwent cysto-ureteroscopy with or without balloon puncture or ureteral stenting. Additionally, 10% received interventional radiology procedures, 6.25% underwent surgical repair, and 4% underwent ultrasound-guided balloon puncture. CONCLUSIONS Female gender, neurologic conditions, and long-term catheterization were identified as predominant risk factors. Early detection of ureteral cannulation can prevent severe complications, particularly in certain special populations such as patients with neurogenic bladder or SCI, who may have reduced sensation and expression capabilities.
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Affiliation(s)
- Jiun-Jia Li
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chin-Fong Au
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Ureteral Obstruction Due to Inadvertent Placement of the Suprapubic Catheter and Bladder Indwelling Catheter: Presentation of Two Clinical Cases and Review of the Literature. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-122856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Suprapubic catheter (SPC) and bladder indwelling catheter (BIC) placement are among the most common urological procedures. Inadvertent misplacement of the catheter tip into the ureteral orifice is an infrequent event with potentially critical complications. Case Presentation: We describe two cases of inadvertent intraureteral misplacement of an SPC and a BIC. A 66-year-old man with chronic kidney disease (CKD) stage G3b, urethral stenosis, long-term SPC who attended the emergency room (ER) 6 hours after the last catheter replacement due to low back pain, fever, deterioration of the general condition, anuria, acute kidney injury (AKI); CT-scan revealed a left uretero-hydronephrosis secondary to obstruction of the catheter balloon misplaced inside the distal ureter. A 59-year-old woman with CKD stage G3b, post-radiotherapy cystitis, and small capacity bladder, long-term BIC who attended the ER a few hours after the last BIC replacement due to abdominal pain, anuria, AKI; CT-scan revealed left hydronephrosis secondary to catheter obstruction within the distal ureter. In both patients, management was conservative, consisting of removing the catheter and repositioning it inside the bladder, in addition to hydration and antibiotherapy. Conclusions: These cases illustrate that awareness of this rare complication can be prevented by confirming the correct positioning of SPC or BIC after its replacement. Early detection and management of this complication can prevent a serious clinical setting.
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Al-zubi M, Alheyassat MMF, Alhasan M, Al-Qudah MHM, Bani-Hani M. Unintended Foley's catheter placement into the ureter: A case report. Int J Surg Case Rep 2022; 100:107750. [PMID: 36244153 PMCID: PMC9574764 DOI: 10.1016/j.ijscr.2022.107750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Foleys catheter insertion is among the most common urological procedures performed by urologists. Case presentation Here we present a case diagnosed with neurogenic bladder before 3 years and she was on long-term indwelling Foleys catheter since that due to urge incontinence and changes her catheter regularly every 10 to12 weeks, where the tip of the catheter was found in the right vesico-ureteric junction with hydronephrosis of the right kidney. Discussion The two most commonly encountered complications of Foley catheter placement are urethral injury and retention of the Foley balloon in the urethra. Misdirection of Foleys catheter into the ureter is a rare complication. Up to our knowledge, only twenty cases have been reported in literature. Conclusion One should keep in mind that inadvertent insertion into the ureter can occur, especially in female patients with neurogenic bladder. Foleys catheter insertion is among the most common urological procedures. The two most commonly encountered complications of Foley catheter placement are urethral injury and retention of the Foley balloon in urethra. Misdirection of Foleys catheter into the ureter is a rare complication.
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Affiliation(s)
- Mohammad Al-zubi
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan,Corresponding author.
| | | | | | | | - Morad Bani-Hani
- Department of Urology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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Garg G, Chawla N, Gogia A, Kakar A. Urinary catheterization from benefits to hapless situations and a call for preventive measures. J Family Med Prim Care 2017; 5:539-542. [PMID: 28217579 PMCID: PMC5290756 DOI: 10.4103/2249-4863.197261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Catheter-associated complications are common, expensive, and often preventable by reducing unnecessary catheter usage. These complications range from most common nosocomial infection to uncommon conditions such as urethral diverticula and ischemic necrosis of the penis. Often, removal of a single known essential cause may be sufficient to prevent a disease. This review raises issues associated with urinary catheterization and emphasizes on the need of preventive measures a physician should take to reduce disappointing situations. The main objective of this literature review is to intercept or oppose unwanted catheter use and thereby, the disease processes associated with urinary catheterization. There is well-described literature available on catheter-associated urinary tract infection, but little is known about noninfectious complications resulting from catheter use; therefore, we also tried to draw attention on these unusual complications.
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Affiliation(s)
- Gunjan Garg
- Department of Internal Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Naveen Chawla
- Department of Internal Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Atul Gogia
- Department of Internal Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Atul Kakar
- Department of Internal Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Inadvertent placement of a urinary catheter into the ureter: A report of 3 cases and review of the literature. Asian J Urol 2016; 4:256-261. [PMID: 29387559 PMCID: PMC5773021 DOI: 10.1016/j.ajur.2016.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/02/2016] [Indexed: 11/23/2022] Open
Abstract
We describe three cases of inadvertent placement of the urinary catheter into the ureter. An 85-year-old gentleman on long-term indwelling catheter (IDC) for neurogenic bladder presented with fever and right flank pain. CT of abdomen and pelvis demonstrated the tip of the IDC to be located within the right vesicoureteric junction with acute right hydronephrosis and acute pyelonephritis. A 74-year-old woman, on long-term IDC for neurogenic bladder was found to have hydronephrosis on ultrasound imaging. Contrast-enhanced CT intravenous pyelography done subsequently showed the IDC was in the right distal ureter. A 47-year-old lady, on IDC for urinary retention and voiding dysfunction likely secondary to schizophrenia and anti-psychotic medications, presented with raised creatinine. A non-enhanced CT of her abdomen and pelvis was done and showed that the tip of the urethral IDC was located up to the left vesicoureteric junction. In all patients, the hydronephrosis resolved after changing the catheter and they were well on discharge. We also review the literature to identify the incidence, outcomes and possible risk factors. To our knowledge, only 20 cases have been reported thus far in the English literature. Although serious complications can occur, the incidence is very low. One risk factor that has been identified is long-term catheterization in patients with neurogenic bladder. We do not recommend routine imaging after catheterization in this group of patients. However, we should still be mindful of the possibility of this occurrence and evaluate and treat as necessary when clinical suspicion arises.
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Crawford RLH, Liston T, Bong AS, Cunnane MJ. Obstructed kidney and sepsis secondary to urethral catheter misplacement into the distal ureter. BMJ Case Rep 2015; 2015:bcr-2014-207757. [PMID: 25976188 DOI: 10.1136/bcr-2014-207757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 86-year-old woman underwent routine catheter replacement in the community. The new catheter failed to drain urine. Attempts to remove the catheter failed, both by the community nurse as well as by the urology team in the hospital. A CT scan confirmed that the catheter balloon was inflated in the distal right ureter. The patient was started on antibiotics and listed for cystoscopy under general anaesthetic. The catheter was visualised entering the right ureter and the balloon punctured using a wire under image intensifier guidance. Once removed, a new catheter was inserted. Very dilated ureteric orifices were noted. Post operatively the patient required HDU support for 48 h due to sepsis and on recovery was discharged home. The key learning point in this case is to always consider catheter misplacement in the ureter if it is not draining well and the patient presents with pain.
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Affiliation(s)
| | - Thomas Liston
- Department of Urology, Worthing Hospital, Worthing, West Sussex, UK
| | - Ai Shiang Bong
- Department of Urology, Worthing Hospital, Worthing, West Sussex, UK
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Çelebi S, Sander S, Kuzdan Ö, Özaydın S, Güvenç Ü, Yavuz S, Kıyak A, Demirali O. Misdiagnoses caused by use of indwelling urethral catheters in children with ureterovesical junction anomalies. Int Urol Nephrol 2015; 47:579-83. [PMID: 25716314 DOI: 10.1007/s11255-015-0934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/13/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Children commonly undergo vesicograms for diagnosing vesicoureteral reflux (VUR). This requires urethral catheterization with transurethral replacement. We report misdiagnosed or related complications due to indwelling urethral catheters unintentionally placed in the ureter. METHODS From our computerized urology records over an 18-year period from January 1995 to May 2013, we retrospectively identified nine cases of 1850 vesicograms that had misdirection of a urethral catheter placed in a ureter. Foley catheters with inflating balloons were used to obtain the vesicograms. RESULTS In all, 1850 vesicograms were performed (746 males, 1104 females; age 1 week to 14 years, mean age 3.8 years) using standard radiological techniques. Size 6-10 Fr indwelling urethral catheters were used, depending on the patient's age and gender. In nine cases (five females, four males), a misdirected urethral catheter was discovered in one of the ureters. The urethral catheter was in the left ureter in four patients and in the right ureter in five patients. Cystoscopic examination found ectopic ureteral openings in six patients: at the bladder neck in four and just below the bladder trigone in two. Three patients in this group with ectopic ureters were followed due a misdiagnosis of VUR. The remaining three patients had grade 3 or 4 VUR. In this group, the catheter passed into the ureter because of the enlarged ureterovesical junction. In one patient with VUR, intraparenchymal fluid leakage and transient hematuria occurred due to the rapid tension increase following the fast injection of contrast with liquid to one ureter. CONCLUSION Although placing an indwelling urethral catheter is a relatively safe procedure, complications can occur, particularly in patients with ureterovesical anomalies, such as high-grade VUR or an ectopic ureter. Using catheters with inflating balloons can cause rapid increases in tension in the ureter, and related complications.
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Affiliation(s)
- Süleyman Çelebi
- Department of Pediatric Surgery, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey,
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Viswanatha RK, Moore CM, Thakar R. Intra-ureteric placement of a urinary catheter in the previously undiagnosed duplex ureter. Int Urogynecol J 2013; 25:143-4. [PMID: 23749239 DOI: 10.1007/s00192-013-2099-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
Abstract
We report the inadvertent insertion of a urinary catheter into the upper moiety ureter of a duplex kidney, in a full-term pregnant woman prior to an emergency caesarean section. The patient complained of severe pain during inflation of the catheter balloon. All measures to deflate the balloon and remove the catheter failed. Retrograde ureteric contrast examination showed the placement of the catheter in the proximal part the right upper moiety ureter of a duplex ureter. The catheter was removed with ureteroscopic forceps. We concluded that congenital variation of the urinary tract can complicate a simple catheterisation.
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Affiliation(s)
- R K Viswanatha
- Department of Obstetrics and Gynaecology, Croydon University Hospital, 530 London Road, Croydon, Surrey, CR7 7YE, UK,
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Adeyemo B, Makovitch S, Foo D. A peculiar complication of suprapubic catheterization: recurrent ureteral obstruction and hydronephrosis. J Spinal Cord Med 2013; 36:166-9. [PMID: 23809534 PMCID: PMC3595967 DOI: 10.1179/2045772312y.0000000080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Suprapubic cystostomy (SPC) catheterization is a common and important technique for the management of vesicular drainage, especially in patients with neurogenic bladder. Some serious complications include bowel perforation and obstruction. FINDINGS A 55-year-old man with C6 American Spinal Injury Association B tetraplegia and a urethral stricture requiring a chronic SPC was admitted for recurrent urosepsis. Computed tomography (CT) of the abdomen revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC (30 French/10-mm silicone catheter with a 10-ml balloon) was removed and replaced with a similar suprapubic catheter (30 French/10-mm silicone catheter with an 8-ml balloon). Symptoms recurred 2 months later and he was readmitted for urosepsis. CT of the abdomen again revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC was removed, and the patient was given a 14 French/4.67-mm urethral silicone catheter with a 5-ml balloon. Follow-up CT of the abdomen 2 months later showed complete resolution of the hydronephrosis and hydroureter. Of note, urodynamic studies 2 years earlier revealed an extremely small bladder with a capacity less than 20 ml. CONCLUSION This case illustrates that obstruction of the ureter by the tip of an SPC can be a cause of recurrent hydronephrosis and urosepsis.
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Affiliation(s)
- Bamidele Adeyemo
- Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA.
| | | | - Dominic Foo
- Spinal Cord Injury Service, Veterans Affairs Boston Healthcare System, Boston, MA, USA
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Baker KS, Dane B, Edelstein Y, Malhotra A, Gould E. Ureteral rupture from aberrant Foley catheter placement: a case report. J Radiol Case Rep 2013; 7:33-40. [PMID: 23372873 DOI: 10.3941/jrcr.v7i1.1276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present the case of a 59 year old female with history of severe neurologic dysfunction from advanced multiple sclerosis who presented with lethargy and oliguria several hours after urethral Foley catheterization. A contrast-enhanced CT scan of the abdomen/pelvis showed an aberrantly placed Foley catheter with its balloon inflated in the proximal left ureter, a rare complication of Foley catheterization with only 5 other cases reported. Incomplete ureteral rupture was demonstrated and confirmed by a followup CT scan in the urographic phase. One of our institution's Interventional Radiologists then placed a nephroureteral stent across the injured ureter to facilitate healing. The patient expired 9 days after the procedure from unrelated sepsis from a chronic stage IV decubitus ulcer, so long term monitoring could not be performed. Following description of our case, we conduct a literature review of presentations, imaging characteristics, and treatment of ureteral Foley catheter placement.
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Affiliation(s)
- Kevin S Baker
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
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Hale N, Baugh D, Womack G. Mid-ureteral rupture: a rare complication of urethral catheterization. Urology 2012; 80:e65-6. [PMID: 22999452 DOI: 10.1016/j.urology.2012.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 11/16/2022]
Abstract
To our knowledge, there are only a few published cases of ureteral injuries secondary to urethral catheterization. We present a case of a ureteral rupture that occurred by placement of a standard 16-Fr urethral catheter. The ureteral injury was identified by computed tomography of the abdomen and pelvis and managed with ureteroureteral anastamosis.
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Affiliation(s)
- Nathan Hale
- Department of Urology, Charleston Area Medical Center, Charleston, WV 25304, USA.
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Agarwal MM, Sandhu JS. Incidental ureteral catheterization with cystometry catheter during video urodynamics: a prompt diagnosis. Urology 2010; 77:71-2. [PMID: 20399489 DOI: 10.1016/j.urology.2010.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 02/02/2010] [Accepted: 02/09/2010] [Indexed: 11/24/2022]
Abstract
Multichannel video urodynamics (VUDS) was performed for postlaparoscopic radical prostatectomy urinary incontinence. A temporary wavy rise was noted in vesical pressure (P(ves)) before filling. Shortly upon filling, a sudden rise was noted in P(ves) and the patient developed left flank pain. The catheter tip was visible fluoroscopically in the left upper ureter and the pump was stopped immediately. After several unsuccessful attempts, the catheter was finally placed under cystoscopic guidance. The left ureteral orifice was at the posterolateral position just at the membranous urethra. The VUDS was completed uneventfully with no further complications. Careful monitoring during VUDS is paramount to detect such complications early, especially in situations of altered trigonal anatomy.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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