International Urology and Nephrology 8 (2), pp. 171--173 (1976)
Non-Deflating Foley Catheter H. U. EICKENBERG, M. AMIN, J. CLARK Section of Urology, Department of Surgery, University of Louisville School of Medicine, Veterans Administration Hospital, and Department of Surgery, University of Louisville School of Medicine, Health Sciences Center, Louisville, Kentucky, U.S.A. (Received July 26, 1975)
The different methods of removal Of a non-deflating ureteral catheter were compared with the styler technique. Two hundred and sixty randomly selected catheters were tested. Overdistention of the balloon with water or air and chemically induced rupture of the balloon produced fragments of various sizes in almost I00 ~. Our styler technique failed to demonstrate any of the complications reported in the literature i.e., chemical or mechanical injury to the bladder or retained rubber fragments causing stone formation.
Difficulty in removing a self-retaining catheter from the urinary bladder may arise from inability to deflate its balloon. In most cases the balloon channel is either blocked by a faulty valve mechanism or some deposit. Various techniques have been described for deflating the balloon or an indwelling ureteral catheter when it cannot be evacuated by aspirating its contents with a needle or syringe through its filling channel. Mechanical rupture of the balloon by overdistention with water or air has been suggested [1 ] and is easily achieved. The rubber used in these catheters, an isoprene derivative, is a polymer of high molecular weight cross-linked by disulfide bonds. Therefore, chemical rupture of the balloon by injecting through the channel small amounts of rubber solvents such as acetone, ether, chloroform, or mineral oil may also be successful [2]. Operative manipulations for deflation of such balloons by aspiration through a needle passed transvaginally or transperineally or by endoscopic manipulation have been reported as well [3-5]. All three methods have disadvantages. Rubber solvents irritate the urothelium. Retained fragments of balloon will induce bizarre stone formation. Overdistention may damage the prostatic fossa or bladder, producing hemorrhage and leaving pieces of broken balloon in the urinary tract. In our experience the deflation of the balloon by insertion of a ureteral catheter stylet through the lumen of the filling tube is without these complications and easily achieved. A small study was done, therefore, to compare this technique with the methods mentioned in the literature and to determine the time involved and the number and size of balloon fragments. International Urology and Nephrology 8, 1976
172
Eickenberg et al. : Non-deflating Foley catheter
Methods and results Two hundred and sixty randomly selected Foley and Silastic catheters with 5 and 30 cc balloons having been used by patients for 1-6 weeks were tested in vitro (Table 1). All balloons were distended with 8 ml of water. The size of the catheter ranged from 18 to 24 French.
Fig. i. Balloon fragment after injection with ether
Fig. 2. Stylet in filling channel pushing valve-like piece of rubber away
The first group of 50 balloons were then overdistended with water to a maximum of 170 ml. All 50 balloons broke, and fragments of various sizes were obtained. Another 50 catheters inflated with air showed the same results. In the third group, 1/2-1 ml ether injected into the water-filled balloon ruptured it in 2 minutes or less in 58 of 60 catheters. In all but two instances a piece of broken balloon was recovered (Fig. 1). Mineral oil took up to 1 hour to dissolve the rubber; of 100 balloons so tested, 95 eventually ruptured and rubber fragments were recovered in all cases but two. Three did not deflate at all. In 39 patients from whom the catheter could not be removed, a stylet (#24) from a ureteral catheter was introduced in the balloon channel in vivo after severing the valve. By advancing the stylet until it reached the inside of the balloon, the patency o f the channel to all but five balloons was re-established as indicated International Urology and Nephrology 8, 1976
173
Eickenber# et aL : Non-deflating Foley catheter
Table 1 Comparison of different techniques Medium
Water (100-- 170 cc) Air (100-- 170 cc) Ether (1/21 cc) Mineral oil (10-20 cc) Stytet* (~24)
Number of catheters
Fragments
50 50 60 100 39
50 50 58 95
No fragments
2 2 34
Ineffective
3 5
* In vivo
by the escape o f balloon contents a r o u n d the introduced wire. The stylet was then removed and the catheter gently withdrawn f r o m the bladder. In every case, the balloon was intact and distending symmetrically. In some cases, close examination showed a small piece o f rubber at the opening o f the filling channel into the balloon which m a y have acted as a one-way valve that was pushed open by the wire (Fig. 2). The time involved was less than 2 minutes, and no balloon fragmented. In the five cases where this technique was ineffective, the balloon was punctured transperineally or transvaginally.
Summary Different methods for removing non-deflating ureteral catheters were compared. Rupture o f the balloon by overdistention or rubber solvents has the disadvantage o f chemical or mechanical injury to the prostatic fossa or bladder, and the retained fragments found after rupture in most cases will induce bizarre foreign b o d y formation and act as a nidus for stone formation. N o n e o f these hazards accompanied the use of a ureteral catheter stylet to re-establish the patency of the filling channel. The technique is simple, safe, causes no fragmentation o f the balloon, and ensures rapid deflation and minimal discomfort.
References 1. Saidinejad, J. : Therapeutische Stellungnahme beim Abrig eines Ballonkatheters. Z. Urol. Nephrol. 64, 135 (1971). 2. Stephens, H. W. Jr. : When the catheter won't come out. Res. & S t a f f Physician, p. 78 (June 1973). 3. Pearman, R. O.: Balloon catheter which will not deflate: Simple method of puncturing balloon. J. Urol. 84, 438 (1960). 4. Seoane, I.: Sonda balon retenida. Su extraccion. Rev. Argent. UroL NefroL 39, 152 (1970). 5. Dees, J. E.: The undeflatable Foley catheter: Another technic for removal. South. Med. J. 65, 236 (1972). International Urology and Nephrology 8, 1976
Non-Deflating Foley Catheter H. U. EICKENBERG, M. AMIN, J. CLARK Section of Urology, Department of Surgery, University of Louisville School of Medicine, Veterans Administration Hospital, and Department of Surgery, University of Louisville School of Medicine, Health Sciences Center, Louisville, Kentucky, U.S.A. (Received July 26, 1975)
The different methods of removal Of a non-deflating ureteral catheter were compared with the styler technique. Two hundred and sixty randomly selected catheters were tested. Overdistention of the balloon with water or air and chemically induced rupture of the balloon produced fragments of various sizes in almost I00 ~. Our styler technique failed to demonstrate any of the complications reported in the literature i.e., chemical or mechanical injury to the bladder or retained rubber fragments causing stone formation.
Difficulty in removing a self-retaining catheter from the urinary bladder may arise from inability to deflate its balloon. In most cases the balloon channel is either blocked by a faulty valve mechanism or some deposit. Various techniques have been described for deflating the balloon or an indwelling ureteral catheter when it cannot be evacuated by aspirating its contents with a needle or syringe through its filling channel. Mechanical rupture of the balloon by overdistention with water or air has been suggested [1 ] and is easily achieved. The rubber used in these catheters, an isoprene derivative, is a polymer of high molecular weight cross-linked by disulfide bonds. Therefore, chemical rupture of the balloon by injecting through the channel small amounts of rubber solvents such as acetone, ether, chloroform, or mineral oil may also be successful [2]. Operative manipulations for deflation of such balloons by aspiration through a needle passed transvaginally or transperineally or by endoscopic manipulation have been reported as well [3-5]. All three methods have disadvantages. Rubber solvents irritate the urothelium. Retained fragments of balloon will induce bizarre stone formation. Overdistention may damage the prostatic fossa or bladder, producing hemorrhage and leaving pieces of broken balloon in the urinary tract. In our experience the deflation of the balloon by insertion of a ureteral catheter stylet through the lumen of the filling tube is without these complications and easily achieved. A small study was done, therefore, to compare this technique with the methods mentioned in the literature and to determine the time involved and the number and size of balloon fragments. International Urology and Nephrology 8, 1976
172
Eickenberg et al. : Non-deflating Foley catheter
Methods and results Two hundred and sixty randomly selected Foley and Silastic catheters with 5 and 30 cc balloons having been used by patients for 1-6 weeks were tested in vitro (Table 1). All balloons were distended with 8 ml of water. The size of the catheter ranged from 18 to 24 French.
Fig. i. Balloon fragment after injection with ether
Fig. 2. Stylet in filling channel pushing valve-like piece of rubber away
The first group of 50 balloons were then overdistended with water to a maximum of 170 ml. All 50 balloons broke, and fragments of various sizes were obtained. Another 50 catheters inflated with air showed the same results. In the third group, 1/2-1 ml ether injected into the water-filled balloon ruptured it in 2 minutes or less in 58 of 60 catheters. In all but two instances a piece of broken balloon was recovered (Fig. 1). Mineral oil took up to 1 hour to dissolve the rubber; of 100 balloons so tested, 95 eventually ruptured and rubber fragments were recovered in all cases but two. Three did not deflate at all. In 39 patients from whom the catheter could not be removed, a stylet (#24) from a ureteral catheter was introduced in the balloon channel in vivo after severing the valve. By advancing the stylet until it reached the inside of the balloon, the patency o f the channel to all but five balloons was re-established as indicated International Urology and Nephrology 8, 1976
173
Eickenber# et aL : Non-deflating Foley catheter
Table 1 Comparison of different techniques Medium
Water (100-- 170 cc) Air (100-- 170 cc) Ether (1/21 cc) Mineral oil (10-20 cc) Stytet* (~24)
Number of catheters
Fragments
50 50 60 100 39
50 50 58 95
No fragments
2 2 34
Ineffective
3 5
* In vivo
by the escape o f balloon contents a r o u n d the introduced wire. The stylet was then removed and the catheter gently withdrawn f r o m the bladder. In every case, the balloon was intact and distending symmetrically. In some cases, close examination showed a small piece o f rubber at the opening o f the filling channel into the balloon which m a y have acted as a one-way valve that was pushed open by the wire (Fig. 2). The time involved was less than 2 minutes, and no balloon fragmented. In the five cases where this technique was ineffective, the balloon was punctured transperineally or transvaginally.
Summary Different methods for removing non-deflating ureteral catheters were compared. Rupture o f the balloon by overdistention or rubber solvents has the disadvantage o f chemical or mechanical injury to the prostatic fossa or bladder, and the retained fragments found after rupture in most cases will induce bizarre foreign b o d y formation and act as a nidus for stone formation. N o n e o f these hazards accompanied the use of a ureteral catheter stylet to re-establish the patency of the filling channel. The technique is simple, safe, causes no fragmentation o f the balloon, and ensures rapid deflation and minimal discomfort.
References 1. Saidinejad, J. : Therapeutische Stellungnahme beim Abrig eines Ballonkatheters. Z. Urol. Nephrol. 64, 135 (1971). 2. Stephens, H. W. Jr. : When the catheter won't come out. Res. & S t a f f Physician, p. 78 (June 1973). 3. Pearman, R. O.: Balloon catheter which will not deflate: Simple method of puncturing balloon. J. Urol. 84, 438 (1960). 4. Seoane, I.: Sonda balon retenida. Su extraccion. Rev. Argent. UroL NefroL 39, 152 (1970). 5. Dees, J. E.: The undeflatable Foley catheter: Another technic for removal. South. Med. J. 65, 236 (1972). International Urology and Nephrology 8, 1976
