# Ureteric Injury From an Indwelling Catheter in the Context of an Undiagnosed Duplex Ureter in a Labouring Woman: A Case Report

## TL;DR

A woman with an undiagnosed duplex kidney system suffered a rare ureteric injury from a routine urinary catheter during labor.

## Contribution

This case highlights a rare iatrogenic ureteric injury from catheterization in a patient with an undiagnosed duplex collecting system.

## Key findings

- A routine catheter was inadvertently placed into the ureter, causing rupture in a woman with a previously undiagnosed duplex kidney.
- Antenatal ultrasound detected a fetal renal anomaly, but maternal imaging was not pursued.
- Emergency cystoscopy and stent insertion were required to manage the injury.

## Abstract

Indwelling urinary catheter (IDC) insertion is routine in obstetric practice and is considered low risk. Inadvertent ureteric catheterisation is rare and has been reported only in a few patients with complex backgrounds, mainly neurogenic bladder. This report describes a case of iatrogenic ureteric injury secondary to IDC insertion in an otherwise well woman, who was later found to have an undiagnosed duplex renal collecting system. Interestingly, an antenatal ultrasound in this case detected a fetal duplex renal collecting system.

The case describes a woman in her thirties in spontaneous labour who had an IDC inserted due to concurrent epidural analgesia. She was noted to have minimal urine output after IDC insertion. She required an emergency caesarean section for a prolonged second stage and fetal tachycardia, and the bladder was noted to be oedematous and high during entry. Further imaging with computerized tomography following the caesarean section demonstrated the duplex collecting system with evidence of ureteric rupture of the lower pole moiety. The IDC was seen to be malpositioned, passing into the left ureter. The patient then required emergency cystoscopy with stent insertion. This case highlights a rare but serious complication related to routine IDC insertion. Consideration of maternal imaging when fetal renal anomalies are detected may be useful in diagnosing maternal duplex systems; however, current evidence does not support this practice.