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CASE REPORT
Year : 2002  |  Volume : 19  |  Issue : 1  |  Page : 83-84
 

Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy


Department of Urology, Royal Hospital, Seeb, Sultanate of Oman

Correspondence Address:
E S Srinadh
Department of Urology, Uro-Nephro Ward, Royal Hospital, Seeb, Area code: 111, Postal code: 1331, Sultanate of Oman

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Source of Support: None, Conflict of Interest: None


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   Abstract 

We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL). To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.


Keywords: Urethral Catheterization: Extracorporeal Shockwave Lithotripsy; Lithotripsy


How to cite this article:
Kunzman SA, Srinadh E S, Lala S M, Albusaidi Q. Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy. Indian J Urol 2002;19:83-4

How to cite this URL:
Kunzman SA, Srinadh E S, Lala S M, Albusaidi Q. Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy. Indian J Urol [serial online] 2002 [cited 2019 Sep 19];19:83-4. Available from: http://www.indianjurol.com/text.asp?2002/19/1/83/21089



   Introduction Top


Retained urethral catheter is occasionally a urological problem. Encrusted balloon of urethral catheter left a long time is a more complicated problem which sometimes necessitates suprapubic cystotomy. We describe a new, ef­fective noninvasive and safe method to remove encrusted non-deflating Foley catheter.


   Case Report Top


A 70-year-old male patient admitted with chronic re­tention of urine for which he was catheterized. He is a known hypertensive, and had history of ischaemic heart disease. Clinical examination was normal. Per rectal ex­amination revealed enlarged prostate. His urine analysis and culture were normal. Biochemical investigations re­vealed hb% 15.3 gr%, creatinine 130 mmol/l. Ultrasonog­raphy revealed normal kidneys and enlarged prostate. He underwent transurethral resection of prostate under spinal anesthesia. The Foley catheter was removed on 4 th post­operative day when the urine became clear. 24 hours later he developed chronic retention of urine again, for which he was recatheterized with a 15-f Foley catheter. It was decided to keep the catheter for a period of 6 weeks as he had bladder atony. He was sent home with foley catheter in situ, and advised to get it removed after 6 weeks at the local hospital. Three months later he returned. to get the catheter removed. Foley bulb failed to deflate despite of all conventional measures. An X-ray of kidney ureter and bladder region revealed stonelike calcification around the bulb of the catheter [Figure - 1]. Since the catheter showed cal­cification it was decided to do ESWL for the fragmenta­tion of the overlying stonelike calcification. He was subjected to the ESWL with Siemens lithostar multiline machine. ESWL was done under sedation, in prone posi­tion. Stonelike calcification localization was done under fluoroscopy. A total of 2560 shockwaves were delivered at 8kV level. The calcification fragmented well in 25 min­utes (100 shock waves per minute). Subsequently the bulb of the catheter deflated and catheter passed out spontane­ously. Fearing that retained stonelike fragments may cause obstruction and as the patient lived in a remote area it was decided to do cystoscopy and remove if there are any large fragments. Cystourethroscopy was done and the flakelike fragments were crushed with lithotrite and washed out. At 3 months follow-up patient was voiding well and a repeat ultrasonography examination revealed no stones in the bladder.


   Comments Top


Patients with retained, non-deflating heavily encrusted Foley catheter suffer from pain in the genitalia, bladder irritability causing spasms and urinary leakage, besides the great discomfort caused by urinary retention. Therefore prompt attention to deflate the bulb and to relieve urinary retention is mandatory. The management of re­tained Foley catheter with encrustation and stone forma­tion around the bulb of the catheter is a complicated problem as the bulb can not be overinflated due to resist­ance offered by the overlying calculus encrustation. Even though the bulb of the catheter is deflated, the coarse ir­regular surface of the bulb due to the encrustation, may result in pain and physical trauma to the urethra when the catheter is removed, increasing the risk of infection. In such circumstance the catheter can be removed by suprapu­bic cystotomy. Since any technique used to deflate the catheter must not disturb the patient or create any addi­tional morbidity, minimally invasive techniques have been preferred over these procedures. Canby-Hagino et al de­scribed using intraluminal pneumatic lithotripsy (Swiss lithoclast) for the removal of encrusted urinary catheters. In each case a pneumatic lithotripsy probe was inserted into the lumen of the catheter and advanced in a jackham­mer like fashion. This technique resulted in disruption of the intraluminal encrustations and straightening of the tubes (nephrostomy tubes and ureteric stents) so that they were removed in atraumatic manner. Even though they recommended its use as first line treatment of removing encrusted urinary catheters its efficacy is not known in case of extraltlminal encrusted urethral catheter. ESWL has proven efficacy and safety in the treatment of the blad­der stones. [2] Borrowing this principle we used ESWL to fragment the stonelike encrustation over the retained Foley catheter balloon. When the overlying encrustation was fragmented by ESWL it resulted in immediate deflation of the balloon and instant relief to the patient. In the present case cystoscopy was done for two reasons : 1) to check any bladder injury; 2) to remove large stone fragments which cannot be passed spontaneously. Retrospectively we believe that the patient might have passed these stone fragments spontaneously. We purpose that ESWL, if fa­cilities are available, should be considered for deflating a retained foley catheter with overlying encrustation, be­fore restoring to endoscopic and surgical techniques. The technique is simple, rapid, non-traumatic, and provides instant relief.

 
   References Top

1.Canby-Hagino ED, Caballero RD, Harmon WJ. Intral_uminal pneu­matic lithotripsy for the removal of encrusted urinary catheters. J Urol 1999; 161: 2058-60  Back to cited text no. 1    
2.Kojima Y, Yoshimura M, Hayashi Y, Asaka H, Ando Y, Kohri K. Extratracorporeal shockwave lithotripsy for vesical lithiasis. Urol Int 1998: 61: 35-38.  Back to cited text no. 2    


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    Abstract
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    Case Report
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    References
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