Mulawkar Prashant Motiram
Division of Clinical and Surgical Sciences, Department Urology, University of Edinburgh, Edinburgh, United Kingdom.
Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India.
J Endourol Case Rep. 2020 Dec 29;6(4):428-430. doi: 10.1089/cren.2020.0157. eCollection 2020.
Straight catheters are usually used for clean intermittent catheterization (CIC). Patients perform CIC without much difficulty. Spontaneous knotting of catheter is rare in large bore straight catheters and female patients. A 50-year old lady, case of neurogenic bladder on CIC inserted a 14F straight catheter, drained some urine but was unable to remove the catheter. She presented in emergency with retention of urine. Her X-ray and ultrasound examination revealed a knotted catheter. Conservative measures to remove the catheter such as forceful injection of radio-opaque contrast and passage of hydrophilic guidewire did not work. She was taken in the operating room. The knot was ablated using holmium laser through transurethral passage of an 8F ureteroscope. Spontaneous knotting of urethral catheter is rare in adults. It should be suspected whenever a straight catheter cannot be removed. Inserting excessive length of catheter is an important risk factor. Holmium laser is an excellent tool to cut the catheter in a least invasive way when conservative measures have failed.
直导管通常用于清洁间歇性导尿（CIC）。患者进行CIC时没有太大困难。大口径直导管和女性患者中导管自发打结的情况很少见。一位50岁患有神经源性膀胱的女性患者进行CIC时插入了一根14F直导管，排出了一些尿液，但无法拔出导管。她因尿潴留急诊就诊。她的X线和超声检查显示导管打结。诸如强力注射不透X线造影剂和亲水性导丝通过等拔除导管的保守措施均无效。她被送入手术室。通过8F输尿管镜经尿道插入，使用钬激光消融结。成人尿道导管自发打结很少见。当直导管无法拔出时应怀疑有打结情况。插入过长的导管是一个重要的危险因素。当保守措施失败时，钬激光是以微创方式切割导管的极佳工具。
