An Unusual Complication of Foley Catheterization in a Child: Urethral Foreign Body.

Iatrogenic urethral foreign bodies are rare conditions in clinical practice, and the relevant data are limited to adult cases in the literature. In this paper, we presented a pediatric case in which a fragment of Foley catheter balloon remained in the posterior urethra. Copyright:

INTRODUCTION

Urethral foreign bodies are rarely seen and usually require urgent surgical intervention.[1] They generally occur due to self-insertion by the patient or iatrogenic causes. Self-inflicted foreign bodies are mostly associated with psychological problems or sexual arousal especially in adults.[12] Iatrogenic cases have been reported mostly in adults, but data are limited in the pediatric literature. To the best of our knowledge, no urethral foreign body has so far been reported as a complication of Foley catheterization in the literature. In this paper, we reported a pediatric case in which a fragment of Foley catheter balloon remained in the posterior urethra.

CASE REPORT

A 10-year-old boy was admitted to our clinic with complaints of difficulty in urination, dysuria and urinary frequency for a week. His medical history revealed that he had been hospitalized in another center 10 days ago due to gastroenteritis-related dehydration, and a Foley catheter had been inserted to monitor urinary output. After a while the catheter had come out spontaneously due to rupture of its balloon, and after this the urination problems of the patient had started. The patient had no obstructive urination complaints prior to the catheterization. General physical examination of the patient was normal. The patient had only microscopic hematuria on the urine analysis. There was no abnormal finding on the pelvic radiography. Since a urinary catheter could not be passed, cystoscopy was planned for the patient. On his cystoscopy, a fragment of the catheter balloon remained within the posterior urethra was detected [Figure 1a] and removed by grasper [Figure 1b]. The patient urinated without any difficulties after the operation, and discharged without symptoms, and remained asymptomatic during his follow-up.

Figure 1

(a) The cystoscopic appearance of the foreign body remained within the posterior urethra. (b) The appearance of the fraction of the catheter after its removal

DISCUSSION

Urethral foreign bodies can develop due to various etiologies including self-infliction, iatrogenic, or traumatic causes.[134] Iatrogenic etiologies are rare conditions in clinical practice, and data are limited to adult cases in the literature.[3] The surgical materials such as sutures and synthetic mesh slings have been reported as urethral foreign bodies in adults after lower urinary tract surgery.[3] Urinary catheterization has been an integral part of medical care since the invention of Foley catheter in the 1930s. The most common complication of Foley catheterization is urinary tract infections. Others are dysuria, hematuria, and urinary tract trauma.[4] On the other hand, a complicated adult case in whom a fragment of Foley catheter balloon remained in the bladder has been previously reported.[5] Our case is the first one in which this unusual complication occurred in the posterior urethra of a child.

Patients have some symptoms at presentation such as difficulty in urination, dysuria, hematuria, painful erection, pain in the urethra or penis.[3] In most of the cases, foreign bodies can be detected by pelvic radiographs.[12] However, it is not always possible to detect non-opaque objects on the radiographs, as in our case.

Definitive management of the patients is aimed at complete removal foreign bodies without any complications. Although there are many extraction methods depending on the type and localization of the foreign body, endoscopic methods are primarily recommended for the treatment.[13] In our case, we removed the foreign body endoscopically without any complications. Another important issue is that, these objects should be urgently removed as early as possible. If the treatment is delayed, complications such as urethritis, chronic cystitis, periurethral abscess, fistula, urethral stenosis, and urethral diverticulum may develop.[2] Since the foreign body did not cause complete obstruction in the urethra, and urinary tract infection, these undesired complications did not develop in our patient despite the delayed diagnosis.

In conclusion, the diagnosis of iatrogenic foreign bodies in the urethra requires a high index of suspicion in children. A careful history and further evaluation with cystoscopy are absolutely crucial for the diagnosis and prevention of complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's father has given consent for images and other clinical information to be reported in the journal. The patient's father understands that the names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.