Delay in diagnosis of urethral perforation due to catheterisation in a person with cervical spinal cord injury. Importance of (1) imaging studies done promptly for detection and documentation of urethral trauma, (2) Urethrotech catheterisation device to minimise urethral trauma and achieve successful catheterisation: A case report

INTRODUCTION AND IMPORTANCE: Spinal cord injury patients are at risk for urethral trauma during catheterisation. We report a patient in whom urethral perforation due to catheterisation was not recognised for ∼ four days. CASE PRESENTATION: Following a routine catheter change by community nurses in a male person with tetraplegia, the catheter drained only a small amount of urine. Therefore, the patient attended the hospital where the staff removed the catheter but could not place a new catheter. The doctor tried different catheters and on fifth attempt, inserted a catheter. The patient continued to bypass urine and was prescribed Solifenacin. On self-referral to spinal unit, urethral trauma was suspected. CT of pelvis revealed the balloon of the Foley catheter in the penile urethra at penis base with the tip projecting beyond the penile shaft. Suprapubic cystostomy was done. The patient continued to leak urine from the penis; required penile sheath drainage and an additional leg bag. CLINICAL DISCUSSION: This case illustrates the value of CT of pelvis including the penis in detecting urethral trauma and misplacement of the catheter. Physicians should look for symptoms and signs of urethral trauma and incorrect positioning of the catheter. Imaging studies should be done without delay to assess urethral trauma and misplacement of urinary catheter. CONCLUSION: We use Urethrotech urethral catheterisation in patients in whom the first attempt to insert a catheter per urethra is unsuccessful, or in patients with a history of difficult catheterisation. This helped to minimise urethral trauma and achieve successful catheterisation.