Pitfall in insertion of suprapubic catheter in patients with spinal cord injuries

Objective: To report an unusual presentation of a misplaced suprapubic catheter (SPC) in a spinal cord injury (SCI) patient. Design: A case report of a SCI patient in whom a SPC was 'partially misplaced' in an emergency. Setting: London Spinal Injuries Unit, Stanmore, UK. Subject: A 33-year-old man who sustained a C5 SCI in a road traffic accident 6 months ago. He had an indwelling urethral catheter, which blocked off and repeated attempts to reinsert another one per urethra were unsuccessful. Main outcome measure: A SPC was inserted in an emergency at the bedside, as he developed autonomic dysreflexia. The catheter initially drained clear urine but subsequently the flow became intermittent. He also started complaining of lower abdominal discomfort. Results: The abdominal examination was unremarkable without signs of peritonism. An ultrasound scan of the abdomen revealed the eye of the catheter in the bladder but the balloon had been inflated in the subcutaneous tissues. It was reinserted under cystoscopic control in the operating theatre. Conclusion: The insertion of a SPC in a neuropathic patient can be a challenge even for an experienced urologist. As these patients often have small capacity bladders, the SPC should be inserted under cystoscopic control wherever possible. However if they are inserted blindly there should be a high index of suspicion for the potential complication of a misplaced catheter. The patient should undergo regular abdominal examination and an ultrasound scan should be performed as soon as possible for confirmation.