Advantages Of Silicone Foley Catheter

Silicone Foley catheters tend to become stiffer as size of the catheter increases

. Whereas the tip of a size 12 French silicone, Foley catheter is soft and flexible, a size 24 French silicone, Foley catheter is distinctly stiff. Chronically inflamed neuropathic bladders are susceptible to perforation by the tip of a Foley catheter. We report a patient with multiple sclerosis and moderately severe chronic cystitis, in whom a size 22 French Foley catheter burrowed through the dome of urinary bladder.

Case presentation

A 55-year-old, Caucasian male suffering from multiple sclerosis underwent suprapubic cystostomy in January 2007. Initially, a size 16 Fr. silicone, Foley, catheter was inserted. During subsequent catheter changes, silicone Foley catheters of progressively increasing sizes were inserted and in July 2007, a size 22 Fr. catheter was used in order to prevent blockages and consequent bypassing of urine. In April 2008, he had an uneventful change of suprapubic catheter; but a week later, this patient developed profuse bypassing. On examination, suprapubic catheter contained fresh blood; there was hardly any urine in the leg bag, which was attached to suprapubic catheter. Cystogram showed localised extravasation of contrast on the superior aspect of urinary bladder around the tip of Foley catheter, which protruded beyond the dome of urinary bladder. The size 22 Fr. catheter was removed and a size 20 Fr silicone, Foley, catheter was inserted ensuring that the tip of catheter pointed towards bladder neck. This patient received gentamicin intravenously and he was prescribed ciprofloxacin for five days. He did not develop temperature or other features of sepsis. Bypassing stopped completely.

Conclusion

In this patient, bladder biopsy had shown moderately severe chronic inflammation and congestion. We learn from this case that we should have used a smaller size catheter, which has a softer texture and changed the catheter at shorter intervals rather than insert a larger bore catheter, and run the risk of perforation of neuropathic bladder by the tip of a stiff Foley catheter.

Rupture of the bladder in persons with multiple sclerosis can result from a combination of several factors. Outflow obstruction from neurogenic sphincter disturbance, chronic bladder infection, direct mechanical trauma from an indwelling catheter, and potentiation of infection by corticotrophin may all play a part. Harding and associates reported bladder rupture in two patients with multiple sclerosis and both patients had chronically inflamed bladders [1].

Perforation of the urinary bladder associated with long-term indwelling catheter is a rare and lethal iatrogenic disorder. Hughes and associates [2] reported an 80-year-old-white man, who had Foley catheter drainage of urinary bladder for more than five years; in this patient, the tip of Foley catheter eroded through the dome of the bladder. Pressure necrosis from contraction of urinary bladder on catheter tip is believed to be the pathogenesis for erosion of bladder by the tip of a Foley catheter [3]. Spees and associates [4] reported three unusual situations of bladder perforation in patients who had a history of long-term urinary bladder catheterization: one in which a fibroid uterus probably played a role in pressure necrosis of a bladder with an indwelling catheter, one in which carcinoma of the prostate and faulty catheter drainage was present, and one in which pelvic radiation therapy was followed by bladder perforation. Neuropathic bladder with chronically inflamed bladder wall is another situation where the tip of long-dwelling catheter can erode into the bladder wall. We report a patient with multiple sclerosis and moderate active chronic inflammation of vesical mucosa, in whom the tip of a size 22 French silicone Foley catheter burrowed through bladder wall.

by: ericfu

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