Malpositioned Foley catheter in right ureter

Case contributed by Dr. Jacob Burns


Post C-section #3 presenting with difficult urination. Patient had Foley catheter placed following C-section with minimal blood-tinged urine. Foley was replaced three more times throughout the day with no return. On the fourth attempt with no return of urine patient was sent for urethrocystogram. Based on findings, CT pelvis was obtained to confirm diagnosis.

Patient Data

Age: 30 years
Gender: Female

Case managed by residents Dr. Jader, Dr. McGeary, and Dr. Burns

Scout image prior to cystourethrogram.

Initially, through gravity drainage, 30% Cystografin was unable to get into the urinary bladder. Subsequently, by hand injection, the right distal ureter is demonstrated with evidence of inflated balloon and the catheter tip seen in the distal ureter. Patient was then transferred to CT for further examination.

The inflated balloon and the tip of the Foley catheter are seen in the right distal ureter. The urinary bladder is distended with normal smooth contour. No evidence of abnormal fluid collection is seen. Enlarged uterus with a small air collection are consistent with post C-section changes. The bony structures are grossly normal.

Case Discussion

This case shows a Foley catheter placed in the distal right ureter. During the fluoroscopy exam, contrast medium traveled up to the renal pelvis; however, this image was not captured. CT pelvis confirmed the diagnosis. Recommended urgent urology opinion.

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