導尿管誤置誘發輸尿管開口息肉與醫源性阻塞：臨床與影像表現

楊証傑^1,2,3、李建達^1,2、沈敬棟^1,2

¹國軍臺中總醫院 外科部 泌尿科，²國防醫學大學，³三軍總醫院 外科部 泌尿外科

From Misplacement to Obstruction: A Case of Iatrogenic Ureteral Orifice Polyps Secondary to Foley Catheterization

Cheng-Chieh Yang^1,2,3, Jane-Dar Lee^1,2, Jing-Dung Shen^1,2

¹ Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, ² National Defense Medical University, ³ Division of Urology, Department of Surgery, Tri-Service General Hospital

Introduction: Foley catheterization is a routine urologic procedure, yet complications may arise, particularly in patients with long-term indwelling catheters

Case Presentation: The patient is a 55-year-old man diagnosed with catatonic schizophrenia in a stuporous state and has been residing in a nursing home for 4 years. He has had long-term Foley catheterization for the past 2 years. He was brought to our urology outpatient department due to fever and was diagnosed with a urinary tract infection. According to the nursing staff, the patient had undergone routine monthly Foley catheter exchange three days prior and subsequently developed urinary leakage from the urethra alongside the catheter. Computed tomography of the abdomen revealed that the tip of the urethral catheter had migrated into the lower third of the right ureter, causing right-sided moderate hydronephrosis.

Cystoscopic examination showed mucosal abrasion and polypoid lesions around the right ureteral orifice, rendering the ureteral orifice unrecognizable; thus, diagnostic ureteroscopy was not performed. Subsequently, we reinserted the Foley catheter in the operating room. Follow-up renal sonography performed the next day revealed minimal improvement in the severity of hydronephrosis. We consulted a radiologist for antegrade Double-J ureteral catheterization. After a peroid of antibiotic therapy, the patient was eventually discharged in stable condition.

A follow-up cystoscopic examination after 6 weeks revealed a reduction in the size of the polypoid lesions near the right ureteral orifice, and diagnostic ureteroscopy identified the right ureteral orifice located within a cellule between two trabeculations, which resembled a gate.

Discussion: Foley catheter misplacement into the ureter is a rare but serious complication. The following conditions have been recognized as the predominant risk factors for inadvertent ureteral catheterization. First, long-term indwelling catheterization, which causes the bladder to contract, decreases its capacity, and leads to trabeculation. Second, neurological disorders such as stroke, spinal cord injury, and multiple sclerosis can lead to bladder hyperactivity characterized by spasms, eventually reducing bladder capacity, increasing bladder pressure, and causing trabeculation. Because of the small capacity and poor elasticity secondary to trabeculation, the Foley tip is less likely to follow the bladder wall spontaneously and can easily become trapped in the cellule.

Conclusions: This case highlights the importance of vigilance in long-term catheter management and imaging in recurrent urinary tract infections.