A peculiar complication of suprapubic catheterization: Recurrent ureteral obstruction and hydronephrosis

The Journal of Spinal Cord Medicine, 2013 · DOI: 10.1179/2045772312Y.0000000080 · Published: January 1, 2013

Spinal Cord Injury Urology Research Methodology & Design

Simple Explanation

Suprapubic cystostomy (SPC) catheterization is a common technique for managing bladder drainage, especially in patients with neurogenic bladder. This case report describes a patient with tetraplegia who experienced recurrent hydronephrosis (swelling of the kidney due to urine build-up) and urosepsis (UTI leading to sepsis) due to the tip of the SPC obstructing his ureter. The patient's condition improved only after the SPC was removed and replaced with a urethral catheter, suggesting the SPC was the cause of the obstruction. The patient remained asymptomatic at the 1-year follow-up visit.

Study Duration

Not specified

Participants

A 55-year-old man with C6 American Spinal Injury Association B tetraplegia

Evidence Level

Level 4, Case Report

Key Findings

1
The tip of the SPC caused recurrent obstruction of the right distal ureter, leading to hydronephrosis and urosepsis.
2
The patient had an extremely small bladder capacity (less than 20 ml), which likely contributed to the catheter's tendency to migrate into the ureter.
3
Removal of the SPC and placement of a urethral catheter resolved the hydronephrosis and hydroureter, and the patient remained asymptomatic at the 1-year follow-up.

Research Summary

This case report describes a rare complication of suprapubic catheterization (SPC) where the catheter tip caused recurrent ureteral obstruction, leading to hydronephrosis and urosepsis in a patient with tetraplegia and a small bladder capacity. The obstruction was resolved by removing the SPC and replacing it with a urethral catheter, highlighting the importance of considering catheter migration as a potential cause of recurrent urosepsis in patients with SPCs. The authors suggest that clinicians should individualize patient catheter selection and consider whether patients with restrictive bladder capacity might be at increased risk of catheter migration and potential complications.

Practical Implications

Careful Catheter Selection

Clinicians should carefully consider catheter selection, especially in patients with restrictive bladder capacity, to minimize the risk of catheter migration and associated complications.

Secure Catheter Placement

Properly securing the SPC to the outer abdominal wall using various anchoring methods can help prevent catheter migration.

Monitor Catheter Depth

Measure and mark the length of the suprapubic catheter during changes to ensure correct placement depth and prevent migration.

Study Limitations

1
This is a single case report, limiting the generalizability of the findings.
2
The patient had a complex genitourinary history, which may have contributed to the unusual complication.
3
The study does not explore all potential preventative measures in detail.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury