Figure 1: Instillation of contrast media through a Foley catheter to assess proper positioning. The foley catheter tip was found in the right lower ureter, and there was extravasation of contrast media around the right ureter.

Mentions: A 38-yr-old paraplegic woman was referred to a hospital emergency room due to lower abdominal pain following a urethral catheter change. She had no tactile sensation below the level of the umbilicus. Five years before, she had developed neurogenic bladder as a result of a 10th thoracic spinal cord injury. Her bladder was being drained using a urethral Foley catheter. She had no evidence of vesicoureteral reflux. On the day of admission, a catheter change had been performed by the nursing staff, using 14-Fr Foley catheter without undue events. In order to determine the location of the tube and rule out bladder rupture, cystography was performed. There was considerable leakage of contrast media around the midureter, and the Foley catheter tip was observed to be located at the right lower ureter (Fig. 1). After removal of the Foley catheter, cystoscopy was performed. The bladder mucosa was intact and both ureteral orifices were in a typical position and normal shape. Ureteral stenting failed because guide wires could not be passed over the injured site. A new urethral catheter was properly inserted and percutaneous nephrostomy was performed (Fig. 2A). Two weeks later, antegrade urography showed that the injured ureter had healed without leakage or obstruction (Fig. 2B).

Kim MK, Park K - J. Korean Med. Sci. (2008)

Bottom Line: During a routine urethral catheter change in a 38-yr-old woman, a 14-Fr Foley catheter was accidentally placed into the right ureter through the ureteral orifice.The position of the catheter was confirmed by retrograde urogram through urethral catheter.Percutaneous nephrostomy was performed with subsequent proper replacement of a urethral catheter.

Affiliation: Department of Urology, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Korea.

Abstract: We report an unusual complication caused by urethral catheterization. During a routine urethral catheter change in a 38-yr-old woman, a 14-Fr Foley catheter was accidentally placed into the right ureter through the ureteral orifice. The position of the catheter was confirmed by retrograde urogram through urethral catheter. Percutaneous nephrostomy was performed with subsequent proper replacement of a urethral catheter. Two weeks later, the injured ureter had healed without leakage or obstruction.