Unintentional ipsilateral ureteral cannulation causing bilateral obstructive uropathy and azotemia in multiple sclerosis

Lower ureteral obstruction secondary to a misplaced or migratory suprapubic or transurethral Foley catheter is a rare event. We recently encountered recurrent lower right ureteral transurethral Foley catheter misplacement causing abdominal pain, worsening azotemia and sequential bilateral obstructive uropathy. Notably, on both occasions, in May 2016 and again in October 2016, initial interpretations of the CT scan of the abdomen missed the diagnosis. We submit that in patients with shrunken neurogenic bladders together with dilated lower ureters (hydroureters), such as in patients with multiple sclerosis and spinal cord injury, there is a need for a more cautious approach in the placement of both transurethral and suprapubic Foley catheters