Bhandari Tika Ram, Shahi Sudha, Mahaseth Naveen
Department of General Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal.
Department of ENT, National Academy of Medical Sciences, Kathmandu, Nepal.
Ann Med Surg (Lond). 2018 Aug 29;34:14-16. doi: 10.1016/j.amsu.2018.08.017. eCollection 2018 Oct.
Longterm indwelling urethral catheter can cause several complications such as lower urinary tract infections, tissue damage, pain, hemorrhage and encrustation of catheter leading to blockage. A 55- year old male presented with suprapubic pain for three months owing to poorly draining Foley catheter. He had undergone surgery for bladder calculi two and half a years back. He had been discharged with Foley catheter. He did not show up at the hospital for two and half years. The catheter was never changed during this period. Plain X-ray abdomen revealed a large encrustation with radiopacity surrounding the foley's bulb. Open suprapubic cystostomy was performed. The intact Foley catheter with encrusted bulb was removed. His postoperative period was uneventful. Surgical removal is the only treatment of choice for unusual massive encrustations in long-term indwelling urethral catheter. Minimally invasive technique is getting popularity, however we performed open cystostomy and removal due to the lack of expertise and instruments in our hospital setting. Catheterization under aseptic condition, frequent catheter change, early treatment of urinary infection and proper patient education on catheter hygiene are few methods that can reduce the complications of longterm indwelling urinary catheter.
长期留置导尿管可引发多种并发症,如下尿路感染、组织损伤、疼痛、出血以及导尿管结痂堵塞等。一名55岁男性因Foley导尿管引流不畅出现耻骨上区疼痛3个月。他在两年半前接受了膀胱结石手术,出院时留置了Foley导尿管。此后两年半他未到医院就诊,在此期间导尿管从未更换。腹部平片显示Foley导尿管球囊周围有一大块不透光的结痂。遂行耻骨上膀胱造瘘术,完整取出带有结痂球囊的Foley导尿管。术后恢复顺利。对于长期留置导尿管出现的罕见大量结痂,手术切除是唯一的治疗选择。微创技术正日益普及,但由于我院缺乏相关专业知识和器械,我们进行了开放性膀胱造瘘和切除手术。无菌条件下导尿、定期更换导尿管、早期治疗泌尿系统感染以及对患者进行正确的导尿管卫生教育是减少长期留置导尿管并发症的几种方法。