CASOS CLINICOS-ingles--64

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GUIDE WIRE KNOT DURING DOUBLE J CATHERTER INSERTION: CASE REPORT
REFERENCES AND RECOMMENDED READINGS
(*of special interest, **of outstanding interest)
Case Reports
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A. Linfoma no hodgkin primario de testículo. Un
nuevo caso. Actas Urol Esp 1999; 23: 789-791.
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G, Tejido Sánchez A, García de la Torre JP, Leiva
Galvis O. Linfoma testicular primario. Presentación
de un caso. Actas Urol Esp 2002; 26: 129-132.
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Arch. Esp. Urol. 2011; 64 (2): 129-132
GUIDE WIRE KNOT DURING DOUBLE J
CATHERTER INSERTION: CASE REPORT
Eduardo Useros Rodriguez, Ignacio Tomas Castillon
Vela, Maria Eugenia Leon Rueda and Angel Nellyt
Silmi Moyano.
Urology Department. Hospital Clínico San Carlos. Madrid.
Spain.
Summary.- OBJECTIVE: To report one case of intrapyelic
loop of a guide wire during double J catheter insertion.
METHODS: We report the case of a 24 year-old female,
with the diagnosis obstructive uropathy secondary to pelvic
tumor who required double J catheter insertion for urinary
diversion. A loop of the guide wire was formed during
the procedure which was finally solved without aggressive
measures.
@
CORRESPONDENCE
Eduardo Useros Rodríguez
Servicio de Urología
Hospital Clínico San Carlos
Prof. Martín Lagos, s/n
28015 Madrid (Spain).
eduseros@yahoo.es
Accepted for publication: April 14th, 2010
130
E. Useros Rodríguez, I. T. Castillón Vela, M. E. León Rueda, et al.
RESULTS: We report the case of a rare complication
appeared during urinary catheter insertion procedure, as
well as a review of the current literature.
CONCLUSION: The use of guide wires and endourological
catheters is not free of complications that may require
aggressive measures to be solved.
Keywords: Loop. Guide wire. Double J catheter.
Urinary drainage.
Resumen.- OBJETIVO: Presentar un caso de formación
de un bucle intrapiélico en una guía endourológica durante la colocación de un catéter doble J.
MÉTODOS: Presentamos el caso de una paciente de 24
años diagnosticada de una masa pélvica que produce
uropatía obstructiva, en la que se produjo un nudo en la
guía del catéter doble J durante el proceso de colocación,
situación que se resolvió finalmente son recurrir a medidas
agresivas.
RESULTADOS: Presentamos el caso de una rara complicación de la cateterización de la vía urinaria y su solución,
así como una revisión de la literatura al respecto de casos
similares.
CONCLUSIÓN: Los procesos de derivación endourológica de la vía urinaria no están exentos de complicaciones,
de variado origen e importancia, y que pueden requerir
medidas agresivas para su resolución.
Palabras clave: Nudo. Guía. Cáteter doble J.
Derivación urinaria.
INTRODUCTION
FIGURE 1. Intrapyelic loop of the catheter guide.
indication for emergency left upper urinary tract
drainage was set.
Cistoscopy was done, showing ortotopic meatus. A
straight ureteral catheter was introduced, reaching the
renal pelvis with difficulty. Terumo® guide wire was
introduced through the catheter. A double J catheter was
then introduced over the guide wire after withdrawal of
the straight catheter, reaching the renal pelvis. When we
pulled the guide wire to withdraw it, a resistance was
noticed that made it impossible. Fluoroscopic images
showed a loop of the guide wire at the renal end of the
double J (Figure 1). After several failed trials, loop was
unlocked by means of back and forward movements
of the Terumo“ guide under fluoroscopic image control
(Figures 2,3,4). Finally, double J ends were properly
set on pelvis and bladder (Figure 5).
Double J ureteral catheter is a basic element for urinary
drainage, used in many fields of Urology, from lithiasis to
renal transplantation. Endourologic procedures such as
ureteral catheterization are not free of complications.
We describe a case of knot formation of a catheter
guide wire during an emergency urinary drainage
procedure.
CASE REPORT
24 years old female with the diagnosis of pelvic highgrade chondrosarcoma, treated with chemotherapy
after surgery rejection, with right hydronephrosis due
to extrinsic compression drained with chronic double
J ureteral catheter. A worsening in renal function
was detected as a consequence of newly developed
left hydronephrosis related with fast progression of
her oncological disease. In the light of these findings
FIGURE 2. Procedures to undo the knot.
GUIDE WIRE KNOT DURING DOUBLE J CATHERTER INSERTION: CASE REPORT
131
DISCUSSION
Urinary drainage by means of double J ureteral catheter
is the favorite urological procedure to solve obstructive
pathology of the upper urinary way compromising renal
function. An early drainage of acute obstruction of the
upper urinary tract is determinant for the recovery of
renal function. There are other factors that contribute to
the grade of recovery, such as patient`s age, grade of
obstruction and base renal function.
Diverse complications may happen during the
catheterization procedure (1). It is not infrequent to find
resistance to pass through the obstruction area (lithiasis,
stenosis, extrinsic compression…); sometimes it is
impossible, or we may cause an injury to the ureter, the
resolution of which may require from watchful waiting
to chirurgical correction. Sometimes, it is necessary
to exert important pressure to push the catheter over
the guide, and, in a few cases, this pressure ends up
introducing pusher into the vesical end of the catheter,
making impossible to separate both elements after
guide wire withdrawal. When this happens, it may be
necessary to take cystoscope out keeping catheter in
place, and introduce it back in parallel to the pusher,
and then use a pair of forceps to hold the end of the
double J while pulling the pusher. Another possible
problem is the ascent of the vesical end of the catheter
into the ureter, needing to carry out ureterorenoscopy
to retrieve it.
In the present case, after a difficult insertion of the
catheter, withdrawal of the guide was not possible due
to the formation of a loop in the renal pelvis. Fortunately,
the first impulse (pulling the guide strongly) was
inhibited, and fluoroscopic image allowed to diagnose
the problem. Many maneuvers were necessary to
unlock the knot. If this had not been possible, we would
FIGURE 3. Loop is finally managed to be undone.
FIGURE 4. Catheter slides properly over the guide.
have needed to withdraw both guide and catheter and
try a new insertion.
Knotting on guide wires and catheters has been
described in the literature in endourologic procedures,
central venous catheters and epidural analgesia
catheters for pain control (2,3).
Delgado Oliva et al. describe a similar case of a loop
between a double J catheter and the guide wire (4)
during ureteroscopy, which concluded with nephrectomy
of the affected kidney. In our case, guide movements
turned out to be enough to undo the loop without need
of aggressive procedures.
There have also been described cases of intravesical
knotting between a urethral catheter and a suprapubic
cystostomy catheter, that were both solved without
agressive measures (5,6).
FIGURE 5. Catheter stays properly set.
132
R. Molina Escudero, F. Herranz Amo, M.C. Navas Martínez, et al.
CONCLUSIONS
Case Reports
The use of guide wires and catheters in endourology
can entail complications during the procedures. Guide
wire knotting is a rare complication the solution of
which may require complex surgical interventions.
Arch. Esp. Urol. 2011; 64 (2): 132-135
METASTATIC PROSTATE CANCER ON THE
THYROID CARTILAGE: UNUSUAL SYMPTOMS
OF PROSTATIC ADENOCARCINOMA. CASE
REPORT
REFERENCES AND RECOMMENDED READINGS
(*of special interest, **of outstanding interest)
**1. Vallejo Herrador J, Burgos Revilla FJ, Álvarez Alba
J, Sáez Garrido JC, Tellez Martínez-Fornes M, Sánchez de la Muela P, et al. El catéter ureteral doble
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3. 3. García-Saura PL, Castilla-Peinado G, Parras-Maldonado MT. Formación de un nudo verdadero en
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Martí JL, Gómez Pérez L, Broseta Rico E, Jiménez
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endourológico: a propósito de un caso. Actas Urol
Esp, 2006;30(3):331-4.
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rama derecha de la arteria pulmonary. Cir Cir, 2003;
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unusual complication of cystourethrography in children. An Esp Pediatr, 2000; 53(6):601-3.
R. Molina Escudero, F. Herranz Amo, M.C. Navas
Martinez1, J. Tabares Jimenez, A. Husillos Alonso, G.
Ogaya Pinies and C. Hernandez Fernandez.
Urology Service. Hospital General Universitario Gregorio
Marañón. Madrid.
Urology Service. Hospital Universitario Puerto Real. Cádiz.
Spain.
Summary.- OBJECTIVE: To review the unusual
localizations of metastasic prostate cancer with the
contribution of a clinical case of prostatic adenocarcinoma
metastasis in the thyroid cartilage.
METHODS: 49-year-old-male admitted with history of 48
hour hematuria associated with lumbar pain radiating to
the lower extremities and cervical tumour for 3 months.
@
CORRESPONDENCE
Roberto Molina Escudero
Urology Service
Hospital General Universitario
Gregorio Marañón
Doctor, Esquerdo 46
28007 Madrid (Spain).
robersescu@hotmail.com
Accepted for publication: May 4th, 2010