Purple Urine Bag Syndrome- A Rare Clinical Entity in Chronic Urinary Catheterization: A Case Series and Literature Review

Abstract

Objectives: To identify the potential causative factors and outcomes for PUBS in chronic catheterized patients. Patients and Methods: An observational case series study of patients with PUBS was conducted from January 2011 to June 2013. The demographic data, co-morbidities, indications, duration of chronic catheterization, Debility score (Bartel index), types, material and color of urinary catheters were assessed. Blood chemistries, urine analysis, urine cultures and required imaging were done in all the affected patients. Outcomes of treatment and follow-up of minimum 1 year was done in all patients. Results: Total of 14 patients of PUBS with chronic urinary catheterization were enrolled in the study with mean (SD) age of 52.8 (14.3) years. All the cases had catheter associated urinary tract infection, alkaline urine and seven different bacterial species isolated in urine culture. Constipation was noted in 9 (64.3%) patients. Other features noted were encrusted retained catheter, vesical calculus, neurogenic bladder, stricture urethra and renal failure. After treatment, purple discoloration of urine subsided in 12 patients. Two patients had persistent PUBS. Conclusion: PUBS is a rare entity where the causative factors were constipation, chronic catheterization, urinary tract infection, alkaline urine and chronic debilitated patients in our study cohort. Surgical correction of the underlying disease and treatment of symptomatic UTI can reduce the likelihood of this problem.