Aberrant Foley catheter placement into the proximal right ureter

Abstract

A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention -is there a role for open surgery?Sir,We read with interest this paper [1] but we were surprised that the role of laparoscopic ureterolithotomy was not explored. We have not undertaken open ureterolithotomy at King's College Hospital for the last 3 years. The laparoscopic approach is safe and successful, with a faster recovery time [2,3]. We would value the authors' view on this approach. ReplyWe appreciate the comments by Choi et al.; indeed, the lack of reference to laparoscopic ureterolithotomy in our paper is predominantly because we have little experience with this method. Although laparoscopic ureterolithotomy causes relatively less morbidity than open surgery, it still requires an inpatient stay, a drain left in situ and an operative duration of >60 min, like open surgery. Additionally, leaving a ureteric stent is highly recommended when the ureterotomy is not sutured, and even when the ureterotomy is closed. This would require an additional procedure for removing the stent if left longer with no pull-through thread. The limited experience with this method is another restriction, probably because in this advanced era of endourology, the numbers of patients suitable for laparoscopic ureterolithotomy are limited, as shown by most reported series, which include few (10-25) patients. Currently, we and most others in contemporary urological practice regard ureteroscopy and ESWL as the first-line treatments for managing ureteric stones, and the exact role of laparoscopic ureterolithotomy remains poorly defined. Open surgery similarly has limited indications, but this is a time-tested method that could be used as a salvage procedure after the failure of endourological methods, and rarely as a primary management, when informed patients so desire or wish to avoid multiple endourological procedures.

Inadvertent insertion of a Foley’s catheter through the orifice of a duplex ureter during catheterisation for laparotomy

“…Inadvertent ureteric catheterisation has been reported in the past in conjunction with microtip catheters during cystometry [2][3][4], during routine catheterization with a Foley's catheter in a case of a paraplegic patient [5], and in the case of long-term catheterisation of a fibrotic bladder [6]. Alternatively, similar cases have been reported during retropubic suspension [7] and as the result of suprapubic catheter insertion [8].…”

Obstructed kidney and sepsis secondary to urethral catheter misplacement into the distal ureter

“…[1][2][3][4][5][6][7][8][9][10][11][12] Our case was further complicated due to failure to deflate the balloon, requiring a general anaesthetic and risk of ureteric injury. External compression on the balloon port lumen by the ureter is the likely reason we were unable to deflate the balloon normally.…”

An unusual aetiology of lower urinary tract obstruction

“…This report emphasizes a rare but severe complication of urethral catheterization, namely catheterization of the ureter, which occurs more frequently in empty or low-volume neurogenic bladders [1][2][3]. This case also stresses the importance of using/ developing strategies aiming at urinary voiding without permanent urinary catheterization in neurogenic bladders, such as intermittent selfcatheterization [4].…”