| Author | Affiliation |
|---|---|
| Alexander W. Lipinski, BSN | |
| Jordan R. Pollock, MD, MBA | |
| Nelly Tan, MD | |
| Douglas Rappaport, MD |
ABSTRACT
Case Presentation
An 83-year-old male with a history of prostate cancer and prior prostatectomy presented with lower abdominal pain, urethral leakage, and hematuria after a routine suprapubic catheter exchange, which was found to be incorrectly positioned in the bulbar urethra, leading to obstructive nephropathy with mild hydronephrosis.
Discussion
This case highlights the increased risk of suprapubic catheter misplacement and complications in elderly patients with neurogenic bladder and altered urinary anatomy, particularly after prostatectomy and artificial urethral sphincter placement. It emphasizes the importance of careful management during catheter exchanges in such patients to prevent complications of misplacement.
CASE PRESENTATION
An 83-year-old male with a history of prostate cancer, treated with prostatectomy and artificial urethral sphincter placement, presented with severe lower abdominal pain, urethral leakage, and hematuria following a routine suprapubic catheter exchange. Pelvic computed tomography revealed that the suprapubic catheter had migrated into the bulbar urethra, resulting in malfunctioning catheter and resultant obstructive physiology with bladder distension and mild hydronephrosis (Image 1A, 1B, and 1C).
DISCUSSION
This patient’s history presented several risk factors for complications following a routine suprapubic catheter exchange. Notably, his history of prostatectomy and artificial urethral sphincter placement suggests surgical alterations that may have caused anatomical changes, increasing the likelihood of catheter misplacement.1,2 Long-term catheterization further heightens the risk of complications such as bladder calculi, recurrent infections, granulation tissue formation, and structural changes, which can complicate future catheter exchanges.1,3 Additionally, neurogenic bladder often results in altered bladder dynamics and diminished sensation, masking symptoms of catheter misplacement and predisposing patients to bladder distension and hydronephrosis.2,4 The risk is compounded in older patients, who generally face decreased tissue elasticity, multiple comorbidities, and anatomical changes due to previous surgeries or chronic conditions.1,5
This case underscores the potential for suprapubic catheter malposition and subsequent complications in elderly patients with neurogenic bladder and altered urinary anatomy. The malpositioned catheter placement within the bulbar urethra highlights the need for heightened vigilance and specialized techniques when managing catheter exchanges in patients with altered urinary anatomy, specifically in retracting the catheter after balloon is inflated to ensure position in the bladder lumen. This report serves as a valuable reference for clinicians encountering similar cases and encourages further investigation into optimized catheterization strategies for patients with complex urological histories.
CPC-EM Capsule
What do we already know about this clinical entity?
Suprapubic catheter misplacement can lead to urinary obstruction and nephropathy, especially in patients with altered urinary anatomy and neurogenic bladder.
What is the major impact of the image(s)?
The images clearly show a suprapubic catheter malpositioned into the bulbar urethra, causing bladder distension and mild hydronephrosis.
How might this improve emergency medicine practice?
Careful catheter management and vigilance for misplacement is vital, improving outcomes in patients with complex urinary anatomy.
Footnotes
Section Editor: Christopher Sampson, MD
Full text available through open access at http://escholarship.org/uc/uciem_cpcem
The authors attest that their institution requires neither Institutional Review Board approval, nor patient consent for publication of this case report. Documentation on file.
Address for Correspondence: Alexander W. Lipinski, Mayo Clinic Alix School of Medicine, 13400 E Shea Blvd., Phoenix, AZ 85259, Email: Lipinski.Alexander@mayo.edu. 9:120 – 122
Submission history: Revision received October 2, 2024; Submitted December 11, 2024; Accepted November 25, 2024
Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
REFERENCES
1. Hobbs C, Howles S, Derry F, et al. Suprapubic catheterisation: a study of 1000 elective procedures. BJU Int. 2022;129(6):760-7.
2. Li JJ, Au CF. Inappropriate placement of urinary catheters into the ureter: a case report and literature review. Medicine (Baltimore). 2024;103(15):e37623.
3. Sullivan N, AlRemeithi R, Pourmand A. Suprapubic catheter encasement by bladder stone. Am J Emerg Med. 2022;56:395e5-7.
4. Adeyemo B, Makovitch S, Foo D. A peculiar complication of suprapubic catheterization: recurrent ureteral obstruction and hydronephrosis. J Spinal Cord Med. 2013;36(2):166-9.
5. Bos BJ, van Merode NAM, Steffens MG, et al. The patient pathway for men with chronic urinary retention: treatments, complications, and consequences. Urology. 2022;167:185-90.
