A case report describes the successful aspiration of a non-deflating suprapubic urinary catheter by passing a cannula directly down the fistula tract. It is a relatively safe and simple procedure that can be performed in an accident and emergency department.
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Replacing a long term suprapubic urinary catheter in accident and emergency is not uncommon. They are often in patients with disabling diagnoses. On occasion the balloon will not deflate. This case report highlights a technique used to deflate the balloon after all reasonable avenues had been exhausted.
A bedbound 62 year old woman attended our department. She had multiple sclerosis and her long term suprapubic catheter was not draining. The catheter balloon would not deflate. The valve mechanism was cut off and a fine guidewire was passed down the balloon's insufflation passage, but the balloon would still not deflate. The following action was taken. Gentle traction was applied to the catheter, which brought the balloon close to the internal opening of the fistula tract. An intravenous cannula 18G (Green Venflon) was taken and its hub and cap were removed. A 20 ml empty syringe was attached to the sheathed needle. The sheath was advanced over the cannula needle to hide its point. This blunt end was slowly passed down the fistula close to the catheter wall until resistance was met (presumed to be the balloon). The needle tip was advanced through the sheath and the syringe started to automatically fill with the balloon fluid. Once all the fluid was aspirated the catheter was easily removed. The balloon was intact.
Many methods have been described for overcoming non-deflating urinary catheter balloons. Once techniques to dislodge balloon port obstruction have failed, balloon rupture is the next step. Over distension and chemical rupture can be used1 but tends to leave balloon debris. Percutaneous needle puncture has been used1,2 but is invasive. Transurethral deflation has been successfully described3 using a smaller 23G needle4 and a 20G angiographic catheter.1 Our technique used a trans-fistula approach for the first time and used a larger needle. Figure 1 shows that a 18G needle does not burst the balloon if approached near the base of the balloon. Experimentally this was repeated on a total of 15 Folysil (silicone Foley) catheters sizes ranging from 12 to 16 Ch gauge. All were successfully aspirated without bursting the balloon. Complications of this procedure may include local injury by a poorly guided unsheathed needle, and balloon fragmentation.
Trans-fistula peri-catheter aspiration of a non-deflating suprapubic urinary catheter balloon is a relatively simple procedure to perform in a busy accident and emergency department. It is reproducible and has few potential adverse events.
Mr T S Huseyin performed the procedure described, searched the literature, and wrote the paper. Mr S M Moalypour supervised the procedure, assisted in writing the paper, and is the guarantor.
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