A rare complication of an indwelling urinary catheter - ureteral entrapment

Inappropriate placement of urinary catheters into the ureter: A case report and literature review

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.

Urethral catheter trapped in the ureter removed using holmium laser: An unusual case and review of the literature

Inadvertent placement of a urethral catheter into the ureter is a rare but documented complication of catheterisation. Management becomes more challenging when the catheter cannot be removed using conservative techniques. We present the case of an 85-year-old male with a history of bladder cancer treated with intravesical Bacillus Calmette–Guérin (BCG) therapy who was found to have a urethral catheter stuck in his left ureter on computerized tomography scan after a routine catheter change. The catheter balloon was punctured using ureteroscopy and Holmium laser. Our literature review identified five other cases where a misguided urethral catheter required surgical intervention for removal from the ureter and the different techniques used are discussed. Risk factors appear to be pregnancy and structural changes to the bladder resulting in widened ureteric orifices including BCG therapy. We suggest that laser puncture of an inflated catheter balloon is a safe and effective method for facilitating removal.

Level of evidence:

4

Inadvertent placement of a urinary catheter into the ureter: A report of 3 cases and review of the literature

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.