Foley Catheter Balloon Research Articles

We need to know the treatment urethral injuries

Atom A Ter–Grigorian wrote an interesting review about urogenital disorders after pelvic ring injuries. This paper gives a good overview about many aspects of this problem. Though it is not extremely frequent [1], every urologist should have detailled knowledge about the treatment for all these cases. The damage of the pelvic organs is often associated with the disturbance of integrity of the pelvic ring [2]. The most important risk factor of urogenital injuries is the rupture of the symphyseal joint [3, 4]. Much more frequent than injuries of the bladder are these of the urethra. EAU guidelines on urethral traumas should be followed [5]. Management of urethral injuries remains controversial due to the variety of injury patterns, associated injuries and treatment options. Though we know this fact, most urologists have little experience with these injuries and there is a lack of randomized prospective trials. The overview of the article from Ter–Grigorian can help to find a structure in the management of that difficult varietry of treatments. Injuries of the anterior urethra are mostely caused by blunt or penetrating trauma [6], placement of penile constriction bands, and iatrogenic injuries from instrumentation. Injuries to the posterior urethra occur with pelvic fractures, mostly as a result of motor vehicle accidents [7]. Injuries vary from simple stretching (25%) to partial rupture (25%) to complete disruption (50%) [7]. Urethral injuries in women are rare. Urethral injuries in children are similar to those in adults, although injuries to the prostate and bladder neck may be more common [6, 7]. To find the diagnosis of acute urethral trauma the history always should be kept in mind. A pelvic fracture or any external penile or perineal trauma can suggest urethral trauma [8]. A high–riding prostate at digital rectal examination is an unreliable finding, but is nevertheless important to perform to exclude a concomitant rectal injury. In the absence of blood at the meatus or penile haematoma, urethral injury is very unlikely and can be excluded by catheterization. However, blood at the meatus is associated with urethral injury and urethral instrumentation should be avoided until the urethra is imaged [5]. In an unstable patient, it may be necessary to attempt to pass a urethral catheter. If there is any difficulty, a suprapubic catheter should be inserted under ultrasound guidance and a retrograde urethrogram performed later. In cases of successful urethral catheterization, the correct placement of the Foley balloon catheter inside the bladder must be checked radiographically or with ultrasound once the patient has been stabilized. In penetrating injuries, the type of weapon used, including the calibre of the bullet, helps to assess potential tissue damage. In a conscious patient, a thorough voiding history should be obtained to establish the time of last urination, the force of the urinary stream, whether urination is painful and whether haematuria is present [5]. Anyway, in most cases the most secure way is a dynamic retrograde urethrography for evaluating urethral injury [9]. This important diagnostic should always be used if possible; it is still the gold standard for this severe problem [5].

Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo

Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. Logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8; CI 1.2 - 39.7), and somewhat birth weight (OR 2.1 but CI containing 1). Risk for cesarean section was increased in association with induction of labor in cases of high maternal weight (OR 10.3, CI 16.0 - 67.0), and somewhat of high birth weight (OR 2.3, but CI containing 1). Fetal distress was associated only with maternal weight (OR 15.7, CI 1.3 - 187.8), and neonatal distress only with Bishop score (OR 10.9, CI 1.1 - 108.0). Conclusion Induction of labor in our setting in order to get vaginal delivery is affected of a high risk of adverse outcomes such as failure of induction, cesarean delivery, fetal and neonatal distress. This risk is significantly influenced by maternal weight, birth weight and Bishop score. Lack of worse outcomes between the first and the subsequent attempts to induce labor can be regarded as a reason to try induction even in the presence of unfavorable cervix.

Mucociliary clearance impairment after zygomaticomaxillary-orbital fractures

The purpose of this study was to examine the influence of zygomaticomaxillo-orbitalis (ZMO) fracture and its symptoms on mucociliary transport (MCT). The study encompassed 144 patients who sustained ZMO fracture. A saccharine test was conducted in every patient both on the side of fracture and on the unaffected side. The results were analyzed in connection with the patients' age, sex, degree of injury, method of treatment, time since fracture, and duration of surgery. It was shown that MCT was considerably impaired on the affected side compared with the control side. However, the degree of impairment did not vary significantly in the patients regardless of the analyzed parameters. ZMO fracture induces the disorder of MCT. Balloon Foley catheter in the open reduction of ZMO fracture impairs MCT. The analyzed parameters do not affect the disorders of MCT.

Cervical dilation as a predictor of pregnancy outcome following emergency cerclage

Objective: To determine whether cervical dilation at the time of physical examination indicated cerclage placement can predicts latency and gestational age at delivery. Methods: A retrospective cohort study of all women who underwent physical examination indicated cerclage placement from 1996 to 2011 at Duke University Hospital (DUH) was performed. Physical examination indicated cerclage was defined as cerclage placement after 16 weeks in women with a cervical length of less than 2.5 cm and/or cervical dilation greater than or equal to 1 cm at time of procedure. Subjects were divided into two groups depending on cervical dilation at time of procedure (≥2 cm, <2 cm) for comparison. A multivariate linear regression model for the outcome gestational age of delivery was constructed, controlling for confounding variables. Results: A total of 110 women with complete data were available for analysis. Median gestational age at cerclage placement was similar between the two groups (20.3 vs. 20.3 weeks, p = 0.8). Women with cervical dilatation ≥2 cm dilation delivered at an earlier median gestational age than women with cervical dilation <2 cm (27.0 vs. 35.6 weeks, p < 0.001). Cervical dilation at the time of cerclage placement independently predicted gestational age at delivery while controlling for use of intracervical Foley balloon catheter for membrane reduction, cerclage suture type, history of prior preterm birth, race, insurance status, and tobacco use. Conclusions: Women who receive a rescue cerclage are more likely to deliver at an earlier gestational age when cervical dilation is ≥2 cm at the time of procedure.

Foley Catheter Versus Vaginal Prostaglandin E2 Gel for Induction of Labor at Term (PROBAAT Trial)

Pharmacological methods (e.g., prostaglandins) are the primary means for induction of labor in women with an unfavorable cervix. However, mechanical methods are also used, most commonly a Foley catheter balloon. When used for induction, it has been demonstrated that the Foley catheter and prostaglandins have similar cesarean rates. However, it is unclear whether the rates of fetal distress, postpartum hemorrhage, or other complications differ between the 2 methods. Moreover, there are concerns that the use of the Foley catheter for induction may increase the risk of maternal and neonatal infection. This open-label randomized controlled trial compared the effectiveness and safety of a Foley catheter and vaginal prostaglandin E2 gel for induction of labor in women with an unfavorable cervix in a term pregnancy. The study was conducted in 12 hospitals in the Netherlands between 2009 and 2010. The participants were women with a term pregnancy, singleton gestation, cephalic presentation, intact membranes, an indication for induction, and no previous cesarean delivery. All were randomly assigned to either induction of labor with a Foley catheter (n = 412) or vaginal prostaglandin E2 gel (n = 412). The primary study outcome measure was the cesarean rate. Secondary outcomes included time from intervention to birth and maternal and neonatal morbidity. There was no significant difference in cesarean rates between the 2 groups (23% vs. 20%); the risk ratio was 1.13, with a 95% confidence interval of 0 · 87–1 · 47 (P = 0.38). Findings from a meta-analysis, including the results of this trial, confirmed that use of the Foley catheter for induction does not reduce the cesarean section rate compared with use of prostaglandin E2 gel. Use of the Foley catheter was associated with a lower rate of operative delivery for suspected fetal distress and fewer admissions of newborns to neonatal intensive care units. The only serious maternal adverse events—1 uterine perforation and 1 uterine rupture—occurred in the prostaglandin group. These findings indicate that induction of labor with the Foley catheter in term women with an unfavorable cervix has similar cesarean rates compared with vaginal prostaglandin E2 gel, with fewer side effects.

Amnion graft as a possible source of stem cells for endometrial regeneration after lysis of severe intrauterine adhesions

The current traditional management of severe intrauterine adhesions (IUAs) is hysteroscopic adhesiolysis with application of either an intrauterine contraceptive device or a Foley catheter balloon with reported recurrence in up to 50% of cases. Recently, significant improvement with the use of amnion graft following hysteroscopic lysis of severe IUA was reported. In the present case, endometrial stromal cells (ESCs) were found within and on the surface of amniotic membrane two months after its grafting intrauterine which was confirmed with CD10 immunohistochemistry. Amniotic membrane graft after hysteroscopic lysis of severe IUA, might act as a source of stem cells for endometrial regeneration; a role that will be of great value especially in severe IUAs. Further studies to confirm this finding are warranted.

Comparison of the Efficacy of Foley Catheter Balloon with Dinoprostone Gel for Cervical Ripening at Term

Objective: The purpose of this study was to compare the efficacy of extra-amniotic Foley catheter with intra cervical Dinoprostone gel for preinduction cervical ripening. Study Design: A randomized, prospective study was conducted in the Department of Obstetrics and Gynecology, PGIMS Rohtak on 100 pregnant women admitted for induction of labor. Fifty patients were randomized to receive Dinoprostone gel and 50 patients to receive intracervical, extra-amniotic Foley catheter. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.18 ± 1.81 and 4.6 ± 1.48 respectively, p < 0.001); however, there was no significant difference between the groups. Mean duration of induction to delivery was 18.51 ± 8.52 in Foley catheter group and 18.21 ± 11.13 in prostaglandin group, the difference being statistically insignificant. Among 50 cases of prostaglandin only single dose was sufficient for 23 (46%) cases to induce labor. But in 27 (54%) cases 2nd dose of prostaglandin were required. The expenditure of intervention showed that Rs. 325 were required for induction by prostaglandin as compared to Rs. 60/- for Induction by Foley’s catheter and the difference was highly significant statistically There was no difference between the groups in mode of delivery, infant weight, apgar score and intrapartum complications. Conclusion: In conclusion, although both Foley catheter and dinoprostone gel appear to be effective agents for cervical ripening. Foley catheter causes less fetal distress, cheap and safety profile of Foley catheter is such that it can be used on an out patient basis, but not dinoprostone gel. These results make Foley catheter comparable or even superior to dinoprostone gel for cervical ripening specially in developing countries.

Management of penetrating neck injuries

Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI. Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations. Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected. FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.

Use of Foley’s Catheter to Control Port-Site Bleeding in Bariatric Surgery

Abdominal wall bleeding in the port-site insertion placed during laparoscopic bariatric surgery is often difficult to control. From January 2005 to August 2011, 226 patients underwent bariatric surgery at our institutions. Seventeen patients (7.5%) presented port-site bleeding that could not be controlled with electrocautery and Foley's catheter (24F) was used for bleeding inhibition. Of the 17 patients, there were 12 females (70.6%) and five males (29.4%) with a mean age of 38.35years. Mean body mass index (BMI) was 44.2. Most of bleeding port-sites were located in hypochondrium and were 12-mm size. After the catheter removal (median 36h), bleeding did not recur in any case. There were no other complications related to the port-side bleeding and the Foley catheter placement. Hospital stay was not prolonged due to the use of the Foley catheter. Port-site bleeding in bariatric surgery is a frequent complication. In up to 7.5% of the cases, the haemorrhage cannot be controlled with electrocautery. Compression with Foley catheter balloon is a safe and efficient method to stop bleeding.

Cesarean scar pregnancy: an analysis of 100 cases

To explore the clinical diagnosis and treatment of cesarean scar pregnancy (CSP). The clinical data of 100 CSP patients during the period of January 2003 to March 2011 were collected for a retrospective analysis. Among 100 cases of CSP, there were cases of asymptomatic (45%, n = 45), vaginal hemorrhage (55%, n = 55) and lower abdominal pain (7%, n = 7); among first diagnosed (n = 81), the cases were diagnosed (n = 75) or misdiagnosed (n = 6); among 19 hospital referrals, 18 were confirmed and 1 case was misdiagnosed as choriocarcinoma. Treatments included ultrasound monitoring curettage after UAE (uterine artery embolism) (n = 56), pure ultrasound monitoring curettage (n = 30), laparoscopic lumpectomy after UAE (n = 2), laparoscopic lumpectomy (n = 2), methotrexate only (n = 3), hysterectomy (n = 2), UAE hemostasis (n = 3) and Foley catheter balloon compression hemostasis (n = 2). No significant difference was found in the average duration of pregnancy, average operative hemorrhage volume and operative duration between 2 management groups of curettage after UAE or pure curettage (P > 0.05). But sac diameter and serum level of β-HCG were obviously less in the pure curettage group than those in the UAE group. And the distance between gestation sac and bladder significantly was greater than that in the UAE group; in the pure curettage group, 96.7% existed as an endogenous type and only 36.7% yielded small flow signals. One hundred patients recovered before discharge. A follow-up of patients with curettage after UAE (n = 43) and pure curettage (n = 26) had similar recovery of menstruation. Eight cases (4 in each) were pregnant again during the follow-up. One case of recurrent CSP was treated with curettage after methotrexate. Early diagnosis and early treatment remain the key for a successful treatment of CSP. Color Doppler ultrasound is important in its early diagnosis and treatment. Different therapeutic modalities may be selected according to specific patient conditions.

Trans-cervical Foley catheter balloon versus vaginal prostaglandin E2 suppository for cervical ripening and induction of labor: a prospective randomized controlled trial

Objective To compare the effectiveness and safety of Foley catheter(FC)and vaginal prostaglandin E2 suppository(PGE2,Propess)for cervical ripening and labor induction in fullterm pregnant women with unfavorable cervix.Methods A prospective randomized controlled trial was conducted.Women with a term or post-term,live,singleton fetus in cephalic presentation,intact membranes,Bishop score＜6,not in labor,medically indicated for labor induction from June 2009 to December 2009 in Drum Tower Hospital of Nanjing University Medical School were randomly divided into two groups:FC group(n=64)and Propess group(n=62).In FC group,a 16-F Foley catheter was inserted into patient's cervical canal; once past the internal os,the balloon was inflated with 80 ml saline.Intravenous oxytocin was initiated after the balloon was spontaneously extruded from the cervix or after 24 hours.In Propess group,vaginal Propess was used.x2 or Fisher's exact test and t test were used to compare the outcomes,delivery mode and induction success rate between the two groups.Results There were no significant differences in gestational weeks,Bishop score,indication of induction,improvement of Bishop score,success rate of induction,rate of vaginal delivery,total duration of labor and volume of postpartum hemorrhage between the two groups(P ＞ 0.05,respectively).Propess group had a higher rate of vaginal birth within 24 hours[56.5％(35/62)vs 28.1％(18/64),t=10.37,P＜0.05],a higher risk for excessively frequent and hard uterine contraction[17.7％(11/62)vs 0.0％(0/64),P＜0.05]and lower incidence of oxytocin induction/augmentation during labor[21.0％(13/62)vs 87.5％(56/64),x2 =56.27,P＜0.05]than those of FC group.There were no differences in neonatal Apgar score,meconium staining and neonatal birth weight between the two groups.Puerperal infection occured in neither group.Conclusions Under strict control of indication and aseptic manipulation,Foley catheter was as effective and safe as Propess for cervical ripening with lower risk of excessive uterine activity.It is suggested that Foley catheter could be used for cervical ripening,especially in patients with economic difficulty. Key words: Cervical ripening; Labor; induced; Dinoprostone; Randomized controlled trial

Balloon Foley catheter compression as a treatment for intercostal vessel bleeding

Iatrogenic and non-iatrogenic causes may contribute to intercostal vessel injury; the most common iatrogenic aetiology is thoracostomy and thoracentesis, especially for patients having coagulation disorders (e.g., hepatocirrhosis, liver transplantation and haematopathy). Non-iatrogenic injuries include secondary intercostal vessel injury, such as chest-wall sharp-instrument injury, autogenous haemorrhage of angioma and costal fracture. There are a variety of manoeuvres that can be used in the management of intercostal vessel bleeding.

INDUCTION OF LABOR

background: Labor can be induced through a myriad of ways. The aim of this study was to compare the effectiveness of the intracervical Foley balloon catheter and intra vaginal 3 mg prostaglandin E2 tablet(s) in preinduction cervical ripening at term. Methods: Prospective analytic study of a cohort of 280 women selected through non probability sampling admitted in Obstetrics units, in two private hospitals one at Rawalpindi and the other at Mirpur (Azad Kashmir), from January 2009 to March 2010. All women were randomized to receive an intracervical Foley catheter or prostaglandin E2 tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. Results: There were no differences in mean Bishop Scores between the prostaglandin and the Foley catheter groups. Bishop scores (mean ± S.D.) after ripening were 6.6±0.81 and 6.7±0.86 for the Foley catheter and prostaglandin groups, respectively (P=0.54). The prostaglandin group showed a statistically shorter induction to delivery time compared with the Foley catheter (16.5±2.2 and 20.51±3.89 h, respectively (P&lt;0.01). Both the groups showed no statistically significant difference between the occurrences of spontaneous vaginal delivery. Labor was established in 72% cases of cervical Foley group. On the other hand induction occurred in 76% cases in prostaglandin group. There was no statistical difference between the need of oxytocin infusion for labor augmentation between the two groups and fetal distress was equally frequent in both the groups. Conclusions: Foley catheter was as effective as Prostaglandin E-2 at term for induction of labor with additional advantage of being cheaper, readily available and had no systemic side effects.

An endoscopic approach to reconstruction of skull base defects using a vascular pedicled nasoseptal mucoperiosteal flap

To introduce a method and the clinical effects of repairing skull base defects and dural defects using vascular pedicled nasoseptal mucoperiosteal flaps through an endoscopic endonasal approach. The clinical and follow-up data for 8 patients who underwent endoscopic endonasal reconstruction of skull base defects and cerebrospinal fluid rhinorrhea with a vascular pedicled nasoseptal mucoperiosteal flap between July 2008 and March 2010 were retrospectively reviewed. All patients were male. The age of these patients ranged from 28 to 60 years (average 41 years). The diagnosis for these patients included one hemangiopericytoma of the anterior skull base one olfactory neuroblastoma (type of Kadish C), one ethmoid sinus cancer, three local recurrent cancers of the nasopharynx after radiotherapy, one carcinoid of skull base and one traumatic cerebrospinal fluid rhinorrhea with recurrent intracranial infection. There were six anterior skull base defects and two middle cranial fossa defects. An endoscopic endonasal surgical approach was used for the repair. A pedicled flap using the nasal septal mucoperiosteum based on the posterior nasal artery was harvested from the ipsilateral side. The tissue flap was used to cover the dural defects. The margin was covered with gelatin sponge and fixed with fibrin glue. The nasal cavity was packed with iodoform gauze, a Foley catheter balloon and Merocel in this sequence to secure the flap in place. Nasal packing was removed 5 to 7 days postoperatively. Partial septal flap necrosis was found in one case, but the flaps in the other 7 cases survived. A postoperative cerebrospinal fluid leak occurred in one case 7 days after surgery. This was re-explored and successfully repaired with abdominal fat. All cases healed well, with no delayed cerebrospinal fluid leaks or intracranial infections during the 6 to 24 months follow-up period. The vascular pedicled nasoseptal mucoperiosteal flap is a reliable choice for endoscopic endonasal skull base reconstruction.

Methotrexate therapy followed by suction curettage followed by Foley tamponade for caesarean scar pregnancy

Objectives Caesarean scar pregnancy (CSP) is a very rare and dangerous form of pregnancy because of the increased risk of rupture and excessive hemorrhage. There is currently no consensus on the treatment. We studied if methotrexate (MTX) therapy followed by suction curettage followed by Foley tamponade was a viable treatment for patients with CSP. Study design Forty-five patients with CSP in our hospital received a single dose of 50 mg/m 2 MTX by intramuscular injection. If gestational cardiac activity was seen on transvaginal ultrasound, local injection of MTX was given. After 7 days, suction curettage was performed to remove the retained products of conception and blood clot (CSP mass) under transabdominal sonography (TAS) guidance. After the suction curettage, a Foley catheter balloon was placed into the isthmic portion of cervix. Results Forty-two subjects were successfully treated and 3 subjects failed treatment. The mean estimated blood loss of all 45 patients was 706.89 ± 642.08 (100–3000) ml. The resolution time of the serum β-hCG was 20.62 ± 5.41 (9–33) days. The time to CSP mass disappearance was 12.57 ± 4.37 (8–25) days. Conclusions MTX administration followed by suction curettage followed by Foley tamponade was an effective treatment for caesarean scar pregnancy.

Use of Foley Balloon Catheter in the Resection of High Vaginal Septum

Use of Foley Balloon Catheter in the Resection of High Vaginal Septum

Cervical ectopic pregnancy: hysterectomy specimen examination clarifies the cause of first trimester pregnancy bleeding

A report on a difficult case of first trimester pregnancy bleeding in a 39-year-old woman solved by hysterectomy. The diagnosis was clarified by pathological examination that showed a cervical ectopic pregnancy with perforation.

T‐tube Enterostomy Versus Foley Catheter Enterostomy: Techniques for Different Situations: Reply

Dr. Sanjah Marwah is to be thanked for his comments [1] on my recent article [2] on the use of a Foley catheter enterostomy for postoperative bowel perforation. Dr. Marwah describes some of the difficulties encountered when using a balloon catheter to seal a bowel perforation, and some of these difficulties are beautifully illustrated by photos. For the conditions shown by Dr. Marwah, I fully agree that a T-tube enterostomy is a far better option than a Foley catheter enterostomy. When considering a Foley catheter enterostomy for postoperative bowel perforation, it is imperative to keep in mind the benefits and limitations of this technique as outlined in my article [2]. First, the defect has to be small and the surrounding bowel wall should be viable and solid. Second, it is imperative that the defect can reach the inside of the abdominal wall at a location where a Foley catheter can be inserted through a small stab wound without any tension on the bowel. I believe that these conditions were not met in any of the examples presented by Dr. Marwah. To be more specific, if the perforation cannot reach the inside of the abdominal wall, there is no point in increasing the volume of the Foley catheter balloon. This will, as pointed out by Dr. Marwah, only lead to creating a larger defect in the bowel. For duodenal leaks, I find the Foley catheter technique of no use, as these defects will never reach the abdominal wall without tension. By following strictly the indications and directions for placement of a Foley catheter enterostomy, we have seen no limitations in the oral intake as soon as bowel paralysis has settled. The advantages of the Foley catheter technique are that it provides immediate and full source control and that early enteral feeing is possible. In addition, later operation for closure of an intestinal fistula is rarely required because of spontaneous closure after removal of the catheter. I hope that this technique will not be discredited because of incorrect use.

Localization of Stricture in Crohn's Disease with Foley Catheter

164 Correspondence to: Volkan Genc, Department of Surgery, Ankara University School of Medicine, Pak Oran Sitesi, B5/28, 06450, Cankaya, Ankara, Turkey. Tel: +90-312-3093989, Fax: +90-3125082676, E-mail: volkan@medicine.ankara.edu.tr Received March 26, 2010, Accepted June 29, 2010 Fig. 1. Foley catheter balloon did not pass through the stricturel area and strictureplasty was performed. Localization of Stricture in Crohn’s Disease with Foley Catheter

Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report

BackgroundAlthough complications related to suprapubic cystostomies are well documented, there is scarcity of literature on safety issues involved in long-term care of suprapubic cystostomy in spinal cord injury patients.Case PresentationA 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1) Suprapubic catheter came out requiring reoperation. (2) The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3) Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4) Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5) Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscleConclusionSuprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.