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Traumatic catheterisation: a near miss.

Han-Kuang Chen¹, Alicia Mackowski¹

¹St John of God Subiaco Hospital, Subiaco, Western Australia, Australia.

BMJ Case Reports

|April 17, 2015

Summary

Improper urinary catheter insertion caused patient pain and misdiagnosis. Correct technique is crucial for accurate diagnosis and patient safety in managing bladder outlet obstruction.

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.

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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.