Traumatic catheterisation: a near miss

Area of Science:

• Urology
• Medical Diagnostics
• Patient Safety

Background:

• Acute urinary retention necessitates prompt management, often involving indwelling urinary catheterization.
• The case highlights potential complications arising from incorrect catheter insertion techniques.
• Chronic bladder outlet obstruction can lead to significant bladder pathology.

Observation:

• A 68-year-old male experienced perineal pain immediately after urinary catheterization.
• Initial imaging suggested extravesical catheter placement and hemorrhage.
• The junior doctor admitted to not fully inserting the catheter before balloon inflation.

Findings:

• Cystoscopy revealed no urethral trauma, but a small bladder with a diverticulum.
• The suspected hemorrhage was identified as a thickened bladder wall.
• The diverticulum was misidentified as the bladder on initial CT scan.

Implications:

• Incorrect catheterization technique can lead to patient discomfort and diagnostic errors.
• Thickened bladder walls and diverticula are potential consequences of chronic bladder outlet obstruction.
• Accurate interpretation of imaging and cystoscopic findings is vital for appropriate patient management.