Case

A 34-year old woman, multigravida, with no urological medical history, presented at 38 weeks of pregnancy with urinary retention during induced labour. Delivery was induced due to gestational diabetes. Her previous two pregnancies were delivered vaginally, without complications. A bladder Foley catheter was placed by the midwife, who reported that placement was difficult and insertion was met with some resistance. There was immediate efflux of 600 mL urine. Initially, the catheter was productive. However, during the subsequent hours, urinary production decreased. The patient had received epidural anaesthesia for pain relief but, despite this, she experienced urgency for micturition. The catheter was removed and a new Foley catheter was placed. This was again reported to be a challenging procedure, with notable deep insertion of the catheter. The patient underwent a caesarean section because of very slow progression of labour and a healthy baby was born. During surgery, a full bladder was observed and a urologist was consulted. Inspection of the urinary tract was challenging because of a very enlarged uterus in combination with the caesarean incision in the lower abdomen. Dorsally on the right side of the uterus, a round non-pulsating elastic lesion and a strand going distally were palpated. When the catheter balloon was deflated, the round lesion disappeared. Differential diagnosis included perforation of the bladder, with the catheter placed in the retroperitoneal space. Placement of the Foley catheter in the right ureter was considered, but rejected. The catheter was removed and a new one was placed with balloon intravesically. During the following hours, the patient experienced worsening abdominal pain and ultrasonography showed fluid abdominally and retroperitoneally. Serum haemoglobin was stable, decreasing the likelihood of haemorrhaging. Contrast CT of the abdomen was obtained, which showed a defect of 3 cm in the proximal right ureter with leakage of contrast fluid outside of the urinary system. A substantial amount of free fluid was present in the retroperitoneal space. No contrast leakage around the bladder was seen. These findings indicated that the catheter had been inserted into the right ureter and the insertion itself or the inflation of the balloon caused damage. Findings are shown in Fig. 1. This explains the symptoms of a feeling of full bladder and minimal urine production despite a catheter being in situ.

中文翻译：

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荷兰阿姆斯特丹大学 UMC 本月案例：Foley 导管导致输尿管损伤，这是一种不寻常的妊娠并发症

案件

一名 34 岁多胎妇女，无泌尿系统病史，在妊娠 38 周时出现引产期间尿潴留。由于妊娠糖尿病而诱导分娩。她之前的两次怀孕都是阴道分娩，没有出现并发症。助产士放置了膀胱 Foley 导管，她报告说放置困难并且插入遇到了一些阻力。立即流出 600 毫升尿液。最初，导管是有生产力的。然而，在随后的几个小时内，尿量减少了。患者接受了硬膜外麻醉以缓解疼痛，但尽管如此，她仍感到尿急。移除导管并放置新的 Foley 导管。据报道，这又是一个具有挑战性的过程，导管插入很深。由于分娩过程非常缓慢，患者接受了剖腹产手术，并生下了一个健康的婴儿。在手术过程中，观察到膀胱充盈，并咨询了泌尿科医生。泌尿道的检查具有挑战性，因为子宫非常增大且下腹部剖腹产切口较大。在子宫右侧的背侧，触诊到一个圆形的非搏动弹性病变和一条向远端延伸的线。当导管球囊放气时，圆形病灶消失。鉴别诊断包括膀胱穿孔，导管置于腹膜后间隙。考虑在右侧输尿管放置 Foley 导管，但被拒绝。移除导管，并在膀胱内放置一根带有球囊的新导管。在接下来的几个小时里，患者腹痛加重，超声检查显示腹部和腹膜后有积液。血清血红蛋白稳定，减少了出血的可能性。腹部增强CT显示右输尿管近端缺损3cm，对比液漏出泌尿系统。腹膜后间隙存在大量游离液体。未观察到膀胱周围的造影剂渗漏。这些发现表明导管已插入右侧输尿管，并且插入本身或球囊的膨胀造成了损坏。结果如图 1 所示。 这解释了尽管有导尿管但仍感觉膀胱充盈和尿量少的症状。腹部增强CT显示右输尿管近端缺损3cm，对比液漏出泌尿系统。腹膜后间隙存在大量游离液体。未观察到膀胱周围的造影剂渗漏。这些发现表明导管已插入右侧输尿管，并且插入本身或球囊的膨胀造成了损坏。结果如图 1 所示。 这解释了尽管有导尿管但仍感觉膀胱充盈和尿量少的症状。腹部增强CT显示右输尿管近端缺损3cm，对比液漏出泌尿系统。腹膜后间隙存在大量游离液体。未观察到膀胱周围的造影剂渗漏。这些发现表明导管已插入右侧输尿管，并且插入本身或球囊的膨胀造成了损坏。结果如图 1 所示。 这解释了尽管有导尿管但仍感觉膀胱充盈和尿量少的症状。未观察到膀胱周围的造影剂渗漏。这些发现表明导管已插入右侧输尿管，并且插入本身或球囊的膨胀造成了损坏。结果如图 1 所示。 这解释了尽管有导尿管但仍感觉膀胱充盈和尿量少的症状。未观察到膀胱周围的造影剂渗漏。这些发现表明导管已插入右侧输尿管，并且插入本身或球囊的膨胀造成了损坏。结果如图 1 所示。 这解释了尽管有导尿管但仍感觉膀胱充盈和尿量少的症状。就地。