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

Clinical Implications

Bladder stones account for 5% of all urinary stone disease and are commonly caused by lower urinary tract obstruction (Hammad, Kaya, & Kazim, 2006). Occasionally, bladder calculi can develop on a foreign body, such as a misplaced suture, eroded surgical mesh, ureteral stent, or virtually any foreign object introduced into the bladder (Solomon, Koff, & Diokno, 1980). Patients with Foley catheters most commonly develop calculi related to the balloon. Eggshell calculi can develop around the Foley balloon and then shed into the bladder where they serve as a nidus for further stone formation. Additionally, a fragment of a ruptured Foley balloon can be retained in the bladder and serve as the nidus (Amendola, Sonda, Diokno, & Vidyasagar, 1983; Juan et al., 2004). In this case, the Foley catheter itself was not the foreign body that induced stone formation. Instead, it appeared the patient inadvertently introduced pubic hairs into his bladder during catheterization, and this served as the nidus for stone formation.

Pubic hair-induced bladder stones have been previously reported (Amendola et al., 1983; Derry & Nuseibeh, 1997; Solomon et al., 1980; Zeitlin, Cottrell, & Lloyd, 1957). One series reported the incidence to be less than 0.8% (Amendola et al., 1983). In patients with foreign bodyinduced calculi, specifically those with a hair nidus, stones are predominantly calcium phosphate (Amendola et al., 1983). The majority of these patients are males with spinal cord injuries who had been practicing proper sterile technique with clean intermittent catheterization (CIC) prior to diagnosis (Amendola et al., 1983). This case was unique in that the patient's stones were composed primarily of struvite. This occurrence was attributed to the growth of pseudomonas and serratia in his urine at the time of diagnoses, both of which are known to increase the likelihood of struvite stones. Of note, the bladder stones RS had in 2003 were primarily ammonium urate but also contained struvite. Since the removal of the stones, RS has not had a recurrence in the past eight months.