Mid-ureteric injury resulting from malposition of an indwelling urethral catheter

We describe a case of a gentleman in his late 70s with left ureteric injury secondary to insertion of a urethral catheter into the left ureter. The resulting left ureteric injury required emergency percutaneous nephrostomy (PCN) insertion.This patient presented acutely to the urology service with haematuria and presumed urinary tract infection owing to a pre-existing bladder cancer diagnosis. A urethral catheter was inserted on admission for monitoring urine output and when his urethral catheter was noted to be blocked with clot overnight it was changed to a larger catheter.An 18Ch catheter was inserted and he experienced pain on balloon inflation. Owing to his background and presentation, a repeat staging CT scan was performed, which identified that the catheter balloon was inflated in the mid left ureter.The catheter was removed and within 4 hours the patient began reporting severe left abdominal pain with localised tenderness on examination. A CT urogram revealed a urine leak secondary to a left mid-ureteric injury. He was transferred the following morning to the regional centre for PCN.