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Int Urol Nephrol (2015) 47:579–583
DOI 10.1007/s11255-015-0934-z
UROLOGY - ORIGINAL PAPER
Misdiagnoses caused by use of indwelling urethral catheters
in children with ureterovesical junction anomalies
Süleyman Çelebi · Serdar Sander · Özgür Kuzdan ·
Seyithan Özaydın · Ünal Güvenç · Sevgi Yavuz ·
Aysel Kıyak · Oyhan Demirali
Received: 27 November 2014 / Accepted: 13 February 2015 / Published online: 26 February 2015
© Springer Science+Business Media Dordrecht 2015
(five females, four males), a misdirected urethral cath-
eter was discovered in one of the ureters. The urethral
catheter was in the left ureter in four patients and in the
right ureter in five patients. Cystoscopic examination
found ectopic ureteral openings in six patients: at the
bladder neck in four and just below the bladder trigone
in two. Three patients in this group with ectopic ure-
ters were followed due a misdiagnosis of VUR. The
remaining three patients had grade 3 or 4 VUR. In
this group, the catheter passed into the ureter because
of the enlarged ureterovesical junction. In one patient
with VUR, intraparenchymal fluid leakage and transient
hematuria occurred due to the rapid tension increase
following the fast injection of contrast with liquid to
one ureter.
Conclusion Although placing an indwelling urethral cath-
eter is a relatively safe procedure, complications can occur,
particularly in patients with ureterovesical anomalies, such
as high-grade VUR or an ectopic ureter. Using catheters
with inflating balloons can cause rapid increases in tension
in the ureter, and related complications.
Keywords Indwelling urethral catheters · Ureterovesical
junction anomalies · Ectopic ureteral openings
Introduction
Children commonly undergo urethral catheterization for
vesicograms when diagnosing vesicoureteral reflux (VUR)
and for urodynamic studies. For this purpose, a catheter is
inserted in the bladder through the urethra, and contrast
material is injected at a constant pressure, with the volume
based on the weight of the child. Insertion of an indwelling
urethral catheter is a relatively safe procedure and is fairly
Abstract
Purpose Children commonly undergo vesicograms for
diagnosing vesicoureteral reflux (VUR). This requires
urethral catheterization with transurethral replacement.
We report misdiagnosed or related complications due to
indwelling urethral catheters unintentionally placed in the
ureter.
Methods From our computerized urology records over an
18-year period from January 1995 to May 2013, we retro-
spectively identified nine cases of 1850 vesicograms that
had misdirection of a urethral catheter placed in a ureter.
Foley catheters with inflating balloons were used to obtain
the vesicograms.
Results In all, 1850 vesicograms were performed (746
males, 1104 females; age 1 week to 14 years, mean
age 3.8 years) using standard radiological techniques.
Size 6–10 Fr indwelling urethral catheters were used,
depending on the patient’s age and gender. In nine cases
S. Çelebi (*) · Ö. Kuzdan · S. Özaydın · Ü. Güvenç ·
O. Demirali
Department of Pediatric Surgery, Kanuni Sultan Suleyman
Education and Research Hospital, Istanbul, Turkey
e-mail: celebisuleyman@hotmail.com
S. Çelebi
Tahtakale mah. T32 cad. Bizimevler 4 C2, D:48 Ispartakule-
Avcılar, Istanbul, Turkey
S. Sander
Department of Pediatric Urology, Kanuni Sultan Suleyman
Education and Research Hospital, Istanbul, Turkey
S. Yavuz · A. Kıyak
Department of Pediatric Nephrology, Kanuni Sultan Suleyman
Education and Research Hospital, Istanbul, Turkey