Malposition of catheters during voiding cystourethrography

Area of Science:

• Pediatric Urology
• Radiological Procedures
• Medical Device Complications

Background:

• Voiding cystourethrography (VCUG) is a standard diagnostic tool for evaluating pediatric urinary tract infections and abnormalities.
• Proper catheter placement is crucial to avoid complications and ensure accurate diagnostic imaging.
• Understanding potential malpositioning events is essential for patient safety and procedural refinement.

Observation:

• A retrospective review of 843 voiding cystourethrography procedures in children (aged 1 week to 12 years) was conducted.
• Three cases (0.36%) demonstrated inadvertent catheter insertion directly into the ureter.
• All identified cases of ureteral catheterization occurred in patients with a history of urinary tract infection.

Findings:

• Ureteral catheter entry was exclusively observed in conjunction with ipsilateral uretero-vesical reflux.
• The study suggests that catheter insertion into the ureter is facilitated by pre-existing anomalies or pathology at the vesicoureteric junction.
• No complications were reported in the remaining 840 procedures, indicating the rarity of this specific malposition event.

Implications:

• These findings underscore the importance of careful catheter manipulation during VCUG, particularly in children with suspected or known vesicoureteric junction abnormalities.
• Enhanced vigilance and potentially modified techniques may be warranted in pediatric patients with a history of urinary tract infections to prevent ureteral catheterization.
• Further research could explore specific risk factors and preventative strategies for catheter malposition in pediatric urogenital imaging.