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Had foley catheter, sore kidney, feeling pressure. Scared of leaking from bladder. Done bladder surgery. Thoughts?

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Practicing since : 1991
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I had bladder surgery to repair damage done during a hysterectomy. I've had a foley catheter for 6 weeks because another puncture was made after surgery.Dr. thinks it will heal by itself. Cystoscopy is on thusday. I have had UTI and on amox but today I have a lot of white particles and stringy bits in urine. Left kidney was sore last night and now I feel a lot of pressure . The catheter seems to be draining ok but I feel like I have a lot of urine inside. That is scaring me....don't want to leak from bladder again. I developed bowel obstruction in hospital from leaking. Thoughts?
Posted Wed, 26 Sep 2012 in Men's Health
Answered by Dr. G.Srinivasan 1 hour later

Thanks for your query.
It is unfortunate to know your situation.
Bladder injury during hysterectomy can happen in less than 1 percent of cases.
If recognized during the surgery, is corrected immediately.
If recognized late, need repair after about 3 months after confirming the position and the size of the opening by cystoscopy.

I would be happy to opine better if u can upload the exact details- operation notes and discharge summary.
Also, kindly let me know if you have urine leak inspite of the catheter.

The white particles and bits need treatment only if u have fever, otherwise will settle once the puncture heals by itself or by surgery.
It is always worth the trial of catheter for a few weeks initially to wait for spontaneous healing which will avoid another surgery.

Awaiting your response.

Above answer was peer-reviewed by
Follow-up: Had foley catheter, sore kidney, feeling pressure. Scared of leaking from bladder. Done bladder surgery. Thoughts? 2 hours later
Thank you for your response. I have no urine leak around the catheter and no temperature. Does the cloudiness mean I am not responding to the antibiotic and might need a different one or do you think the particles are part of the puncture healing? I really don't want the cystoscope to be delayed because I still have an infection.

Unfortunately I do not have the records of surgery, etc. although my husband wants to request them. We really aren't sure exactly what happened... there seem to be different versions among the doctors (which is unsettling a bit).

Also, the urologist seems confident that the remaining puncture will heal itself and no surgery will be needed. The gyn. keeps saying I will definitely need surgery to repair it and not to get my hopes up. What is your experience with this?
Answered by Dr. G.Srinivasan 12 hours later

Thanks for your reply.
Kindly get records as they are very important.
I feel the gynec doctor is right as spontanous healing is rare - but it is still possible (if the punture is in the bladder caused due to injury during operation ( vesico-vaginal or ureterovaginal fistula).
As I had said, if there is no fever the color of urine need not be addressed aggressively.
I know u are worried, but let the doctor decide the time of cystoscopy. You will benefitted if you do not let your anxiety score over the decision making process of the doctor. Get well soon.

Hope this answers your query.

Above answer was peer-reviewed by
Follow-up: Had foley catheter, sore kidney, feeling pressure. Scared of leaking from bladder. Done bladder surgery. Thoughts? 1 hour later
Thank you so much for your opinion in this. It definitely helps to know that I don't need to worry about the cloudiness or white particles. You are so right about the anxiety component of all this. I have been so hypervigilant since coming home from the hospital. So much went wrong and differing opinions have caused me to question EVERYTHING.

Just to clarify, the remaining puncture in my bladder was made AFTER the surgery a day later when my catheter wasn't draining for 6 hours and I felt a lot of pressure. I was also leaking a great deal when I used the toilet, which immediately relieved the pressure. A nurse or technician said she thought it needed to be repositioned,so she deflated the balloon and advanced the catheter "several centimeters". The days after that I became very ill, burping and vomiting bile, etc. They did a CT scan and discovered that the catheter pushed directly up and through my bladder wall. (My husband saw the scan and said the top of my bladder was pointed, not round.) They did a XXXXXXX test and found the leaking from the top of my bladder. That was when the bowel obstruction, ng tube, etc. began. In short, I think the remaining puncture is somewhat small.

If it has not healed itself, can that kind of repair be done laparoscopically or will I need abdominal surgery? If so, is there any reason to think that I am now prone to bowel obstructions with abdominal surgery or do you think that was caused more by the urine leakage? I am terrified of going through that again. My blood count also dropped very low and blood transfusion was unsuccessful (I developed a fever of 103 for most of that night). No more transfusions were attempted. I am still very anemic and extremely tired.

I think that may be all of my alotted questions...thanks so much for your feedback. It is greatly appreciated and very reassuring to get advice from another doctor. XXXXXXX XXXXXXX
Answered by Dr. G.Srinivasan 7 hours later

Thanks again.
I was almost in the process of discontinuing my online answers as the star rating was unacceptable for my qualification and experience.
But your words make me feel that i need to do such answers more often and i feel happy to have helped someone in trouble.
Coming to your point- U r unlikely to develop intestinal block again as the catheter is in position and draining urine well.
If the puncture does not heal within 2 to 3 months, repair can be undertaken by laparoscopy as well.
If the procedure is difficult, open procedure needs to be done.
Pls keep in mind that such repairs are best done first attempt.
There is always a chance that recurrence / nonhealing of the fistula is common needing a second procedure.
This is not meant to scare you, but u need to know, as anyway u need to sign consent on the same.
If u r reluctant for open procedure, the doctors are likely to try laparoscopy as long as possible and this reduces healing process.
This procedure is straight forward and u r unlikely to develop bowel obstruction as it is done without touching the bowel.

Now is the time to have healthy diet and build yourself as healing after any surgical procedure is dependent on your health before surgery.

Kindly follow your doctors advice and get well soon. I am always there for guidance to the best of my knowledge.


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