|Year : 2001 | Volume
| Issue : 2 | Page : 179-180
An unusual complication of percutaneous suprapubic cystostomy
Dharm Raj Singh, L Sailo, Ninan B Abraham, Nitin Kekre
Department of Urology, Christian Medical College & Hospital, Vellore, India
Dharm Raj Singh
Department of Urology (Unit II), Christian Medical College & Hospital, Vellore - 632004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Suprapubic cystostomy is a commonly performed urological procedure. This case report describes a rare and unique complication which occurred due to a gaping and reflexing ureteric orifice.
Keywords: Suprapubic Cystostorny; Pyelonephritis; Ureteric Catheterization
|How to cite this article:|
Singh DR, Sailo L, Abraham NB, Kekre N. An unusual complication of percutaneous suprapubic cystostomy. Indian J Urol 2001;17:179-80
| Introduction|| |
A rare complication of suprapubic cystostomy is presented in which a Foley's catheter inserted suprapubically went up into the ureter due to a gaping ureteric orifice. The patient presented with features of pyelonephritis and unresolved bladder symptoms for which the catheter was inserted in the first instance.
| Case Report|| |
A 27-year-old man presented with overflow incontinence of urine of 3-months' duration, secondly to traumatic bulbomembranous urethral stricture. Ultrasonography of the abdomen showed bilateral hydroureteronephrosis with thickened bladder wall. The renal parameters were normal. Trocar suprapubic cystostomy (SPC) was done as an outpatient procedure and 14 Fr. Foley's catheter kept as suprapubic drainage. He was admitted 5 days later with persistence of incontinence and features of left pyelonephritis. Catheter blockage was ruled out by gentle saline wash. Later on ascending urethrogram and mnicturating cystourethrograrn were done as part of evaluation. On cystogram, no contrast was seen in bladder but contrast was seen going into the left upper ureter and renal pelvis with Foley's bulb present in upper ureter [Figure - 1]. The catheter was repositioned and subsequent cystogram revealed bilateral reflux. Later he was subjected for perineal urethroplasty.
| Comments|| |
Percutaneous suprapubic cystostomy is a commonly performed outpatient urological procedure. After initial trocar puncture, usually the catheter is pushed till free flow of urine is obtained. If pushed in excessively, then there is possibility that the tip of the catheter can go either down in prostatic urethra or up in the ureter especially if ureteric orifices are gaping, as happened in the present case. Persistence of incontinence after cystostomy was an indirect evidence that bladder was not being drained and development of left pyelonephritis was a consequence of ascending infection. Parikh et al (1993) reported a case in which the tip of the suprapubic catheter was in anterior urethra and balloon was inflated in the prostatic urethra. Patient developed retention of urine on clamping the catheter. 
Berrero et al (1987) have published a case of acute ureteral obstruction after suprapubic catheterization. 
We would like to highlight that after insertion of suprapubic catheter, free flow of urine should always be checked before inflating the catheter balloon. If there is any suspicion, especially in presence of hydroureteronephrosis where ureteric orifices may be gaping, the catheter should be repositioned under radiological guidance to avoid the situation we encountered and the other reported complications in the literature.
| References|| |
|1.||Parikh AM, Chapple CR. Suprapubic catheter: An unusual case of acute retention. Br J Urol 1993; 71: 494-495. |
|2.||Borrero GO. Miller PR. Vora K et al. Acute ureteral obstruction as a complication of suprapubic catheterisation. Urol Radiol 1987; 9: 171-173. |
[Figure - 1]