Urinary bladder is the most common urologic organ exposed to iatrogenic injury. The bladder trauma is classified into extra-peritoneal, intra-peritoneal, or combined trauma. Intra-peritoneal bladder injury is conventionally being treated with open surgical repair, mainly to explore the abdominal viscera for possible associated injuries and to insert peritoneal drain. One rare form of the iatrogenic bladder injury is catheter-related bladder injury which is very uncommon and only few cases were reported. It is mainly related to other associated medical conditions like cancer and chronic catheterization which might be causing subsequent bladder wall weakness. Therefore, it is important to collect more data about this rare type of bladder injury, particularly urethral catheterization which is one of the most common medical procedures. We present a 74-year-old male patient who developed acute kidney injury and was treated by urethral catheterization in the emergency department. The patient developed immediately severe abdominal pain. Non-contrast CT showed intra-peritoneal bladder perforation by the urethral catheter. The patient developed peritonitis and failed a trial of conservative management. Consequently, laparoscopic abdominal exploration and bladder repair was performed successfully.

Urethral catheterization is one of the most common procedures in medical practice. Catheterization is not only restricted for urological purposes, but also used for many other indications. For instance, urethral catheterization could be used for intensive care unit patients, trauma and multiple fracture injuries, and advanced neurological condition e.g. multiple sclerosis. Therefore, it may be performed by both well trained and not fully trained medical professionals resulting in complications. We present an 82-year-old female presented to A&E with hematuria, abdominal pain and low catheter output drainage after recent catheter exchange by the district nurse. Interestingly, non-contrast computed tomography (CT) scan showed the catheter inserted into the left ureter and the catheter balloon was inflated at the level of the mid-ureter. Later contrast CT study showed extravasation confirming ureteric wall partial disruption injury. The patient was managed conservatively without apparent complications in the follow-up.

The penis is one of the end-artery organs in the human body. The blood supply of the penis depends on the internal pudendal artery, which arises from the anterior division of the internal iliac artery. Subsequently, the penis is one of the organs that are highly affected by peripheral vascular disease. Furthermore, erectile dysfunction is a clinical sign that might precede coronary heart disease. Artificial entrapment of the blood into the cavernous bodies is one of the treatment options for erectile dysfunction. In addition, the same concept might be utilized in some sex aids to increase self-pleasure; hence, penile rings are widely used in some cultures. We present here a case of metal penile ring entrapment, which was managed successfully with the help of the hospital maintenance team. Therefore, it is of tremendous importance in unusual cases to seek advice from all possible resources. Such complications should be highlighted to increase the awareness of the users and the medical professionals as well.

Iatrogenic ureteric injury is the most common cause of ureteric injury. It is usually caused by either gynecological or urological surgical procedures. Iatrogenic ureteric injury repair depends mainly on the time of diagnosis. We represent here a case of iatrogenic complete transection ureteric injury resulted from laparoscopic bilateral salpingo-oophorectomy. The patient had a history of abdominal hysterectomy causing adhesions that resulted in challenging surgery. One week later, the patient presented to the emergency department with abdominal pain, and contrast CT showed left hydronephrosis with extravasation of the contrast at the left renal pelvis. The patient was treated initially with left nephrostomy and an antegrade nephrostogram confirmed the diagnosis of complete transection ureteric injury. Surprisingly, left retrograde study, which was done 11 weeks after the operative injury, showed healing of the ureteric injury with a small annular stricture. The stricture was dilated and a stent was inserted. We concluded that conservative waiting and delayed ureteric repair might be advised in similar injuries allowing time for resolution of the postoperative inflammatory reaction and spontaneous healing.

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