(P05) Recurrent Urinary Tract Infections; Workup Reveals Foreign Body in Bladder

Introduction: Urinary tract infections (UTIs) are common among geriatric population, especially those residing in long term care. Recurrent UTIs are complicated in males, often require further workup. While rare, retained intravesical foreign bodies are a possible cause of recurrent UTIs due to several mechanisms, including bacterial colonization, biofilm formation, and irritation to bladder mucosa.

Case Description : Patient is an 83-year-old male with chronic medical conditions of benign prostatic hyperplasia with a chronic indwelling foley due to urinary retention, h/o Urolift surgery, and Vascular dementia. The patient's wife reported since May 2024, pt had been hospitalized five times for recurrent UTIs, h/o cutting his foley catheters with scissors, pulling the catheter. At his first ED visit in May diagnosed with Delirium/Urosepsis. The CT scan of his abdomen and pelvis showed mild bilateral hydroureteronephrosis with distention of the urinary bladder, and possible bladder outlet obstruction, Pt was discharged to acute rehabilitation facility for deconditioning. During his last hospitalization, urology completed a cystoscopy before the time of discharge, which showed a foreign body in a bladder diverticula. The retained foreign body was found to be a retained piece of foley catheter and showed irritation of the bladder around the site as a possible bacterial nidus. A bladder wash with cytology was completed at that time, which was negative for malignant cells. He had a follow up cystoscopy completed on 09/20/2024, which was within normal limits aside from bladder diverticuli. The patient's wife discussed with his urologist about options for catheterization; this decision was complicated due to his history of Vascular Dementia and manually removing his foleys, along with his history of recurrent catheter associated UTIs. The patient was decided to be an unlikely candidate for CIC as he would not let his wife catheterize him. The patient and his wife were advised to continue to monitor symptoms, and to continue using incontinence briefs. At the time of his geriatric follow up visit, the patient had baseline mental status and denied any discomfort in the pelvic region. Patient and his wife denied any urinary symptoms at that time, such as malodorous urine, increased urinary frequency/urgency, hematuria, or suprapubic abdominal pain. He currently does not have a foley in place, and he has not had any urinary complaints/pelvic discomfort since the foreign body was removed.

Discussion: When recurrent UTIs occur, especially in patients with cognitive impairment/dementia, it is worthwhile to consider a differential that also includes a retained foreign body. Patients with cognitive impairment who reside in long term care are especially at risk, as they are often not continuously monitored; this increases the risk of patients tampering with catheters or inserting foreign bodies without the knowledge of caregivers.