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Common post lithotripsy complications include: abdominal pain, nausea and vomiting, ureteral colic, fever, and skin ecchymosis. Supportive therapy with IV fluids, analgesics, and antiemetics may be indicated. Check complete blood count, creatinine, urinalysis, and urine output; use antibiotics if appropriate. Severe flank pain, fall in hematocrit, hypotension, and syncope, can be caused by pernephric and renal hematomas. Diagnosis is by CT or US. Acute management may include IV fluids, blood transfusions, analgesics, and antibiotics. It is important to consult urology early in the process. Rare complications include injury to abdominal viscera and surrounding structures. Consult surgery and urology for these complications.

Complications related to the use of urinary catheters include infection, leakage, obstruction, and trauma during placement. Most catheters are made of latex, but silicone is available for the latex allergies.

Catheter-Related Urinary Tract Infection

Antibiotic treatment of asymptomatic bacteriuria in a patient with a short-term catheter is not recommended. Pyuria is universal for patients with long-term (1 month) indwelling catheters; pyuria should not be used in the diagnosis of asymptomatic infection. Hematuria is a better indicator of infection. CA-UTI in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of symptoms or signs compatible with UTI with no other identified source of infection along with ≥ 103 colony-forming units/mL of ≥ 1 bacterial species in a single catheter urine specimen. Signs and symptoms compatible with CA-UTI include new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause; flank pain; costovertebral angle tenderness; acute hematuria; pelvic discomfort; and in those whose catheters have been removed, dysuria, urgent or frequent urination, or suprapubic pain or tenderness. In those patients with mild symptoms, treatment is ciprofloxacin 500 milligrams twice a day, or levofloxacin 500 milligrams once a day, or cefpodoxime (200 milligrams twice a day. Seven days is the recommended duration of antimicrobial treatment for patients with CA-UTI who have prompt resolution of symptoms (A-III), and 10 to 14 days of treatment is recommended for those with a delayed response. Pyelonephritis is the most common complication of catheter-related UTI with fever. Admission is frequency required. (See Chapter 53 for further antibiotic recommendations). Check urine cultures and blood cultures if septic (see Chapter 89 for septic shock). Replace the catheter if it has been in place > 7 days.

Nondraining Catheters

Obstruction by blood clots is suggested when the catheter is easily flushed, but there is little or no irrigate return. If this occurs, the catheter may be replaced with a triple lumen catheter for bladder irrigation. Sometimes a larger single lumen catheter may aid in the evacuation of larger clots. If there is evidence of continual bleeding after proper irrigation, then consult urology. Long-term indwelling Foley catheters can become obstructed by intraluminal encrustations. Leakage may occur secondary to obstruction or bladder spasms.

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