A CALL FOR APPROPRIATE URINARY CATHETERS IN NEONATES

Johannes Petrus Potgieter, Eliyah Aaron Sischy, Elliot Motloung

[1] Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, Sefako

Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa

Abstract

Introduction: Urinary catheterization using feeding tubes is a common practice in neonates due to the unavailability of appropriately sized urinary catheters in many South African and low-income healthcare facilities. Although generally safe, complications such as intra-vesicular knot formation can occur, leading to significant clinical challenges.

Case report: We report on a case of a premature twin neonate who presented with a small intestinal atresia requiring surgical intervention. A size 6Fr feeding tube was used as a urinary catheter intraoperatively, as our

facility does not routinely stock 6Fr urinary catheters. Postoperatively, the catheter could not be removed, and further assessment suggested intra-vesicular knotting. Given the inability to remove the catheter via traction and the unavailability of endoscopic retrieval methods, laparoscopic-assisted cystostomy was performed. The

procedure confirmed a true knot in the bladder, lodged in the proximal urethra.

Discussion: Knot formation is a known but preventable complication of urinary catheterization, particularly with feeding tubes. Factors such as excessive insertion length and catheter material contribute to this risk. The

case highlights the importance of using appropriately designed urinary catheters, optimizing insertion techniques, and increasing accessibility tominimally invasive interventions such as laparoscopy.

Conclusion: This case underscores the need for proper catheter selection and insertion techniques in neonates. Advocacy for improved resource availability and training in catheterization methods is essential to minimize preventable complications and improve patient outcomes.