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Role of Portable Transabdominal Ultrasonography in Migrated Foley’s Catheter with Intact Balloon After Radical Prostatectomy — A Learning Experience
Nikunj O Goel*, HS Veerendra*, Prashant Lad**, JN Kulkarni***
 

Rupture of balloon suddenly due to mechanical injury or due to inadvertent injury to balloon during closure. Traditionally they are taken up for cystoscopy for catheter reinsertion. With the help of portable USG this invasive procedure can be avoided. We report such a case.

Introduction
Migration of Foley’s catheter following Trans urethral resection of prostate and Radical Prostatectomy is a common problem faced by Surgeons in a busy oncosurgery clinic. Traditionally this has required cystoscopy for reinsertion of catheter. Here we present an interesting case when we managed a migrated Foley’s after Radical Prostatectomy noninvasively.

Case Report
A 55 year old male with organ confined prostate carcinoma underwent radical prostatectomy with uneventful surgery. Following standard principles Vesico-urethral anastomosis was done by vicryl 3-0 and 18F silicon catheter inserted, bulb inflated to 15 ml saline. For first 6 hrs postoperatively; retropubic drain drained @40-50 ml/hr and urethral catheter only @5-10 ml/hr. In next 18 hrs, retropubic drain showed 1000 ml urine, with catheter showing only 250 ml clear urine. Is there a anastomotic leak? Or, spontaneous rupture of balloon with subsequent catheter migration?

Considering it as leak, plan to inflate balloon by 5 ml saline and to apply traction to check anastomotic leak was made. But we thought to get a trans-abdominal sonography just to check position of balloon. To our surprise, tip of catheter was seen beyond the bladder neck and intact catheter bulb was lying in bulbar fossa. Traditionally, if catheter with inflated balloon migrates it comes and lies in prostatic urethra and patient would be in pain, but in our case patient and a new 18F-silicon catheter inserted which walked in easily, balloon inflated to 20 ml saline and position confirmed by ultrasonography. Within 2 hrs catheter started draining @35-40 ml/hr clear urine and pelvic drainage stopped to 100 ml/24 hrs.

Fig. 1 : Graphic representation of normal anatomy. Fig. 2 : Graphic representation of migrated catheter bulb lying in bulbar fossa.

Discussion
Spontaneous rupture of balloon can be mechanical due to excessive inflation or due to inadvertent injury to balloon during closure. Review of literature shows many cases depicting role of trans-rectal ultrasound in detection of urine leakage from Vesico-urethral anastomosis.1 In our case after detecting leak clinically, trans-abdominal ultrasound was done to detect migrated catheter. Here, catheter bulb was lying in bulbar fossa with tip beyond bladder neck so patient was not in retention. Had it been that we had not done an ultrasound we would have inflated balloon by 5 ml saline more which would have ended with rupture urethra or even anastomotic disruption. Traditionally, such patients were taken back to operation theatre and were subjected to cystoscopy for catheter re-insertion. But with help of portable ultrasonography, this invasive procedure can be avoided.

Conclusion
Advanced non-invasive technologies are emerging as a boon in today’s era of surgery. Knowledge and proper implementation of these advanced technologies definitely help a surgeon in managing these unwanted complications.

References

  1. Lozzi C, et al. Radical prostatectomy; role of ultrasonography in follow up. Arch Ital Urol Nefrol Androl 1992; 64 Suppl
  2. 35-40.

SCHISTOSOMIASIS : THE SILENT PANDEMIC

‘Even small schistosomiasis-associated deficits could represent a substantial public-health burden in view of the large numbers of individuals with schistosomiasis’

More than 200 million people worldwide are infected with chronic schistosomiasis. Charles King and co-workers did a meta-analysis to review the available evidence on disability-associated outcomes for all types of schistosomiasis. The investigators report that human schistosome infection is significantly related to symptoms of diarrhoea, pain, and fatigue, as well as haemoglobin deficit, undernutrition, and reduced exercise tolerance. In a Comment, Lorenzo Savioli and colleagues suggest a need to strengthen the link between deworming programmes and other chemotherapy-based treatments against endemic diseases in poor countries.

Lancet, 2005; 4 :1520, 1561.

ACUPUNCTURE CUTS DAYS WITH TENSION-TYPE HEADACHE

Acupuncture for tension-type headache is more effective than being on a waiting list, but no more effective than minimal acupuncture. People receiving acupuncture had significantly fewer days with a headache than those on the waiting list, but the difference compared with people receiving minimal acupuncture did not reach significance. Acupuncture was well tolerated, and improvements lasted several months after cessation of treatment.

BMJ, 2005; 331 : 376.

*Resident of DNB Urology; **Resident of DNB General Surgery; ***Professor and Head Uro and Gynaec Oncology; Lilavati Hospital and Research Centre, Bandra (W),
Mumbai - 400 050, India. email : docnikunj@yahoo.co.in