A case of ureteral orifice obstruction by bladder indwelling catheter

Abstract

A 91-year-old man with a long-term bladder indwelling catheter (BIC) for benign prostatic hyperplasia (BPH) presented to our emergency department with fever.

Computed tomography (CT) showed the tip of the BIC was located within the left ureterovesical junction, which caused left hydronephrosis and a hydroureter.

The catheter was replaced, and the hydronephrosis improved quickly.

The patient was treated with antibiotic therapy and discharged on day 10.

Catheterization is one of the most common procedures performed by urologists; however, it can lead to unexpected complications.

1 Introduction

Catheterization is generally a straightforward procedure that can be safely performed in most cases. Some complications associated with catheterization have been reported; however, rare complications can occur, especially in patients with obstructions, such as benign prostatic hyperplasia (BPH). In recent years, minimally invasive surgical therapies (MIST), such as prostatic urethral lift (PUL) and water vapor energy therapy (WAVE), have been introduced in Japan for BPH in high-risk elderly patients.

However, there are still many patients, such as bedridden elderly, who have their bladder indwelling catheter (BIC) changed regularly. Here, we report a case of ureteral orifice obstruction caused by a BIC.

2 Case presentation

A 91-year-old man presented to the emergency department with a high fever (maximum body temperature 39.0 °C).

He was elderly and in need of nursing care, almost bedridden.

Over the last few years, he had long-term BIC due to urinary retention caused by BPH, which changed regularly at a community clinic every four weeks. The next exchange was scheduled for three days later. The patient had no relevant medical history.

Laboratory findings showed renal dysfunction (serum creatinine was 1.18 mg/dL, and eGFR was 44.4 mL/min/1.73 m ² ) and inflammation (white blood cell count was 15120/μL). Blood culture yielded negative results. However, the urine culture indicated infections with Klebsiella oxytoca . The physical examination findings were unremarkable. Ultrasonography revealed a left-sided hydronephrosis. Computed tomography (CT) revealed extensive prostatic hypertrophy and urine retention in the bladder. The tip of the catheter was located in the left ureter. The bladder cuff was swollen in front of the ureteral orifice, causing obstruction and hydroureteronephrosis ( Fig. 1 ). CT showed no other cause of fever, and we diagnosed acute obstructive pyelonephritis; he was hospitalized. With little traction on the catheter, the pyuria drained.