SPONTANEOUS INTRAVESICAL KNOTTING OF A CYSTOCATHETER IN A 75-YEAR-OLD MAN

Abstract

Intravesical knotting is a rare complication of urinary catheterization that can make catheter exchange difficult. We report a case involving a 75-year-old man with type 2 diabetes mellitus and recurrent urethral stricture after several unsuccessful endoscopic procedures. The patient had a long-term 12 Fr suprapubic cystostomy catheter and presented for a scheduled exchange without pain, hematuria, or fever. Ultrasound confirmed the intravesical position of the catheter and showed no bladder calcifications. Elastic resistance prevented initial withdrawal. A hydrophilic guidewire was introduced through the catheter lumen, and controlled traction subsequently permitted removal. Examination of the extracted device revealed a tight knot in its distal intravesical portion. A new catheter was inserted, and no immediate complications were observed. Excess intravesical catheter length is a possible mechanism, although it was not measured in this patient. This case illustrates the need to consider catheter knotting when unexpected resistance occurs during suprapubic catheter exchange and to select further management according to the catheter configuration and available access.