Indian Journal of Urology
CASE REPORT
Year
: 2001  |  Volume : 17  |  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

Correspondence Address:
Dharm Raj Singh
Department of Urology (Unit II), Christian Medical College & Hospital, Vellore - 632004, Tamil Nadu
India

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.



How to cite this article:
Singh DR, Sailo L, Abraham NB, Kekre N. An unusual complication of percutaneous suprapubic cystostomy.Indian J Urol 2001;17:179-180


How to cite this URL:
Singh DR, Sailo L, Abraham NB, Kekre N. An unusual complication of percutaneous suprapubic cystostomy. Indian J Urol [serial online] 2001 [cited 2022 Sep 28 ];17:179-180
Available from: https://www.indianjurol.com/text.asp?2001/17/2/179/21060


Full Text

 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. [1]

Berrero et al (1987) have published a case of acute ureteral obstruction after suprapubic catheterization. [2]

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

1Parikh AM, Chapple CR. Suprapubic catheter: An unusual case of acute retention. Br J Urol 1993; 71: 494-495.
2Borrero GO. Miller PR. Vora K et al. Acute ureteral obstruction as a complication of suprapubic catheterisation. Urol Radiol 1987; 9: 171-173.