A Unique Complication of Urethral Catheterization

Pubic Hair Associated With Struvite Bladder Calculi

Sarah Perz, MS; Chandy Ellimoottil, MD; Manoj Rao, MD; Larissa Bresler, MD


Urol Nurs. 2013;33(5):233-235. 

In This Article

Abstract and Introduction


Bladder stones account for 5% of all urinary stone disease and can develop on a foreign body, such as a misplaced suture, eroded surgical mesh, or ureteral stent. In this case study, the authors present a patient with bladder stones associated with pubic hairs introduced during a monthly indwelling Foley catheter change. Clinicians have an important role in instructing patients on the use of proper technique and hygiene practices during urethral catheterization to minimize the potential for urinary complications.


A 65-year-old male (RS) with T11 paraplegia secondary to a motor vehicle accident in 1972 presented to our office for routine follow up. He was found to have asymptomatic renal and bladder stones on surveillance imaging. Since his spinal cord injury, RS had managed his neurogenic bladder with an indwelling Foley catheter. He had been previously instructed on sterile technique and was independently changing his catheter every three weeks. There was no documentation to note whether part of the above instruction included shaving of pubic hairs. Ten years prior to the current episode, he developed bladder stones composed primarily of ammonium urate and struvite. RS was successfully treated with cystolithalopaxy. Past history revealed episodes of asymptomatic bacteriuria, with rare clinically significant infections. During one clinically significant urinary tract infection, bacteria from his urine were cultured, and a variety of species were grown, including Pseudomonas, Enterococcus, Klebsiella and Proteus. He was treated according to urine culture sensitivities. At the time of his presentation, RS was taking prophylactic nitrofurantoin.