title: Use of open-ended Foley catheter to treat profuse urine leakage around suprapubic catheter in a female patient with spina bifida who had undergone closure of urethra and suprapubic cystostomy: a case report.
abstract: BACKGROUND
  Leakage of urine around a catheter is not uncommon in spinal cord injury patients, who have indwelling urethral catheter. Aetiological factors for leakage of urine around a catheter are bladder spasms, partial blockage of catheter, constipation, and urine infection. Usually, leakage of urine subsides when the underlying cause is treated. Leakage of urine around a suprapubic catheter is very rare and occurs in patients, in whom the urethra is closed due to severe stricture or previous surgery.
  
  
  METHODS
  We describe a 35-year-old female patient with spina bifida and paraplegia, who had undergone suprapubic cystotomy followed by urethral closure for leakage of urine per urethra. She developed leakage of urine around suprapubic Foley catheter, which did not subside even after changing the catheter, ruling out vesical calculus, and ensuring that there was no kink in catheter or drainage tube. As a desperate measure, we punched a large hole at the tip of a Foley catheter and used this catheter for suprapubic drainage. Leakage of urine around suprapubic catheter stopped and the patient was greatly relieved.
  
  
  CONCLUSIONS
  Leakage of urine around a catheter requires prompt attention in spinal cord injury patients; otherwise patients can develop maceration of neuropathic skin and pressure sore. Management of spinal cord injury patients with leakage of urine around a suprapubic catheter should include (i) changing the catheter, (ii) prescribing anticholinergic drugs to control bladder spasm, (iii) treating constipation and urine infection when present, (iv) imaging studies or flexible cystoscopy to look for vesical calculus. If leakage of urine persists despite all these measures, use of a modified Foley catheter in which, a large hole has been made at the tip, is worth trying.
authors.affiliation: Regional Spinal Injuries Centre, District General Hospital, Southport PR8 6PN, UK. S.Vaidyanathan@southportandormskirk.nhs.uk
authors.forename: Subramanian
authors.initials: S
authors.lastname: Vaidyanathan
authors.forename: Bakul M
authors.initials: BM
authors.lastname: Soni
authors.forename: Peter L
authors.initials: PL
authors.lastname: Hughes
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh