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

Abstract

SUMMARYAn 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.

Ureteral Rupture Caused by Accidental Intubation of the Ureter with a Foley-Catheter during Ureterorenoscopy

“…Intraureteral misplacement of a Foley-Catheter is a rare complication of bladder catheterization. There are just 14 cases described in literature so far [ 1 , 2 ]. It is common sense that women with neurogenic bladder dysfunction and dilated ureteral orifices are at an especially high risk for this complication [ 2 , 3 ].…”

“…The cases found in literature so far furthermore show that a misplaced Foley-Catheter needs to be diagnosed as fast as possible. Otherwise further complications such as hydronephrosis, pyelonephritis, and consecutive urosepsis can lead to significant long-term damage and even to the patient's death [ 1 , 2 , 4 , 5 ].…”

“…In cases of a ruptured ureter on the other hand Double-J-Stenting of the ureter, retrograde or antegrade via nephrostomy, is inevitable. Still we recommend inserting a Double-J-Stent in all cases of intraureteral misplacement of a Foley-Catheter due to the possible posttraumatic swelling of the ureter [ 1 – 4 , 6 ].…”

“…Aberrant placement of a Foley-Catheter in the ureter is a very rare but yet described complication of bladder catheterization. There are just 14 [ 1 , 2 ] cases described in literature, while none of those happened during a ureterorenoscopic procedure. This makes the case at hand a unique one to learn from.…”

Retrograde Pyelogram during intended Cystogram: A Rare complication of a common procedure

“…Inadvertent placement of urinary catheters in ureters has been reported and known to cause complications such as obstruction,[1] ureteric rupture,[2] sepsis,[3] and tumefaction. [4] It often goes unrecognized till complications occurred as in our case.…”