脊髄損傷患者における自己導尿時の膀胱内カテーテルの遺残：症例報告

Clean intermittent self-catheterization (CISC) is a first-line bladder management strategy for patients with spinal cord injury (SCI). However, complications such as urinary tract infections and stone formation are relatively common. The retention of the catheter as an intravesical foreign body is an exceedingly rare event and can present with symptoms similar to infection or radiolucent calculi.

A 36-year-old male with a history of chronic spinal cord injury (T12, AIS A) utilizing clean intermittent self-catheterization (CISC) presented with urinary frequency and the presence of "gravel-like debris". The patient was afebrile, and initial plain radiography yielded no significant findings. A computed tomography (CT) revealed a high-density tubular structure within the bladder. Cystoscopy successfully removed two urinary catheters, leading to symptom resolution. On gross inspection, neither showed any apparent tear or breakage. An attempt to use a handled catheter was not tolerated; however, after reinforced technique education, including the caregiver, the patient has remained symptom-free for over 12 months with no recurrence.

In CISC users with persistent lower urinary tract symptoms despite empiric UTI management and negative first-line imaging, intravesical foreign bodies should be considered. Early non-contrast CT can clarify radiolucent or atypical etiologies and expedite definitive cystoscopic treatment. Prevention should pair ergonomic catheter selection (e.g. flared or handled designs as tolerated) with structured skills refreshers during routine SCI follow-up; caregiver participation can be included when appropriate.