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CASE REPORT |
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| Year : 2006 | Volume
: 22
| Issue : 3 | Page : 268-269 |
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An unusual cause of acute loin pain during cystometry
AR Rao1, VS Hanchanale2, HG Motiwala1, O Karim1
1 Department of Urology, Wexham Park Hospital, Slough, United Kingdom
2 Department of Urology, Leighton Hospital, Crewe, United Kingdom
Correspondence Address:
V S Hanchanale
Research Fellow, Urology, Leighton Hospital, Crewe, Cheshire, CW1 4QJ
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-1591.27640
 Abstract | | |
We report two cases of inadvertent ureteric catheterization by cystometry catheter causing acute loin pain. Ultrasound of kidneys in the first patient showed the presence of air in the pelvicalyceal system. In the second patient, injection of contrast media confirmed the presence of contrast in the ureter. In both patients, further investigations did not show any evidence of vesico-uretric reflux.
Keywords: Cystometry, inadvertent ureteric catheterization, loin pain
How to cite this article:
Rao A R, Hanchanale V S, Motiwala H G, Karim O. An unusual cause of acute loin pain during cystometry. Indian J Urol 2006;22:268-9 |
| Introduction | |  |
Cystometry is a common investigation performed on patients with lower urinary tract symptoms due to various reasons. It involves introduction of a fine cystometry catheter into the bladder to instill or measure the pressure changes in the bladder. We report two cases wherein the cystometry catheter inadvertently entered the ureter and produced acute loin pain during filling phase.
| Case Reports | | |
Case 1
A 46-year-old lady booked for cystometry due to symptoms of urgency and urge incontinence, had a 6-Fr double lumen catheter passed with ease into the bladder. On filling, patient experienced acute right loin pain for which the procedure was abandoned. Ultrasound was performed, which showed bright acoustic shadowing in the right pelvicalyceal system with some movement, suggestive of air [Figure - 1]. Patient recovered with analgesia and underwent urodynamic evaluation.
Case 2
A 63-year-old lady undergoing video-urodynamics had her bladder catheterized with ease using a 6-Fr double lumen cystometry catheter. However, on filling, the patient complained of severe left loin pain. Due to the previous experience, a possibility of ureteric catheterization was made and after instilling small amount of dye, X-rays were taken to confirm the suspicion [Figure - 2]. The catheter was withdrawn and the procedure was carried out to completion. Voiding phase did not demonstrate any reflux.
| Discussion | | |
Review of the literature yielded only three other cases of inadvertent ureteric catheterization at the time of urodynamic evaluation causing acute loin pain.[1],[2] In these cases, diagnosis in two was based on the fact that the pressure recorded by the sensor at the time of pain was 86 cm H2O and 148 cm H 2O, suggesting ureteric catheterization. In the other report, cystoscopy was performed to confirm ureteric catheterization. Unlike the above cases, radiological evidence confirmed ureteric catheterization in our cases. Aberrant Foley catheter placement into the ureter has also been documented in the literature.[3],[4]
Inadvertent ureteric catheterization is recognized infrequently and reported rarely. So there are no documented complications following such an event, but they could include ureteral trauma, dilation, disruption, upper tract infection.
It has been suggested that the rotation of the catheter once inside the bladder or marked prolapse of the anterior vaginal wall distorting the vesical anatomy may be the predisposing factors.[2] We concur with the Ordonez et al recommendations of insertion of catheter for 6-8 cm prior to rotation.[1] In conclusion, clinicians performing urodynamic evaluation should suspect inadvertent ureteric catheterization if the patient experiences acute loin pain during the filling phase. We recommend repositioning of the catheter and proceeding with the urodynamic evaluation once the pain settles.
| Acknowledgement | | |
Mr. John Fairbank and Sister Janette Garden
| Editorial Comments | | |
This case report highlights an unusual complication which can be encountered during CMG. It is astonishing how these catheters find their way into the ureteric lumen. A video CMG should always pick this up as it will show contrast refluxing along the side of the catheter in the early filling phase of CMG. Authors have mentioned that they were performing video CMG in the 2nd case and ordinarily should have recognized this complication. I have sometimes observed low amplitude regular rhythmic contractions on the bladder line and more often than not this is due to ureteric peristalsis. This peristalsis artefact contractions should alert the physician about the possibility of inadvertent ureteric catheterization. Nevertheless this case report provides valuable information to all who perform urodynamic studies and reinforces that it should always be done with supervision to avoid complications.
| References | | |
| 1. | Ordonez E, Zivkovic F, Moser F, Tamussino K. Inadvertent ureteral catheterizaion with a microtip catheter at cystometry. Int Urogynecol J Pelvic Floor Dysfunct 1998;9:184-5.  [PUBMED] |
| 2. | Gill EJ, Nichols CM. Cystoscopic confirmation of inadvertent ureteral catheterization during cystometry. Int Urogynecol J Pelvic Floor Dysfunct 2002;13:266-7. [PUBMED] [FULLTEXT] |
| 3. | Muneer A, Minhas S, Harrison SC. Aberrant Foley catheter placement into the proximal right ureter BJU Int 2002;89:795. [PUBMED] [FULLTEXT] |
| 4. | Borrero GO, Miller PR, Vora K, Nepjuk CA. Acute ureteral obstruction as a complication of suprapubic catheterization. Urol Radiol 1987;9:171-3. [PUBMED] |
[Figure - 1], [Figure - 2]
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