Purple Urine Bag Syndrome- A Rare Clinical Entity in Chronic Urinary Catheterization: A Case Series and Literature Review

Abstract

Objectives: To identify the potential causative factors and outcomes for PUBS in chronic catheterized patients. Patients and Methods:An observational case series study of patients with PUBS was conducted from January 2011 to June 2013. The demographic data, co-morbidities, indications, duration of chronic catheterization, Debility score (Bartel index), types, material and color of urinary catheters were assessed. Blood chemistries, urine analysis, urine cultures and required imaging were done in all the affected patients. Outcomes of treatment and follow-up of minimum 1 year was done in all patients. Results:Total of 14 patients of PUBS with chronic urinary catheterization were enrolled in the study with mean (SD) age of 52.8 (14.3) years. All the cases had catheter associated urinary tract infection, alkaline urine and seven different bacterial species isolated in urine culture. Constipation was noted in 9 (64.3%) patients. Other features noted were encrusted retained catheter, vesical calculus, neurogenic bladder, stricture urethra and renal failure. After treatment, purple discoloration of urine subsided in 12 patients. Two patients had persistent PUBS.Conclusion: PUBS is a rare entity where the causative factors were constipation, chronic catheterization, urinary tract infection, alkaline urine and chronic debilitated patients in our study cohort. Surgical correction of the underlying disease and treatment of symptomatic UTI can reduce the likelihood of this problem.

A Case Report: An Unusual Presentation of Purple Urinary Bag Syndrome

“…In one case series, the neurogenic bladder was the most common indication for catheterization associated with PUB, followed by posterior and anterior urethral stenosis. Urological intervention for the strictures was not associated with the recurrence of PUBS following treatment, but one-third of neurogenic bladder patients had a recurrence of the discoloration after antibiotic therapy [13]. Furthermore, the discoloration persisted before the initiation of antibiotic therapy despite multiple catheter replacements.…”

Purple Urine Bag Syndrome; Infeksi Saluran Kemih Langka Terkait Penggunaan Kateter Uretra Menetap

“…2 PUBS secara visual jarang ditemukan, pertama kali diekspos oleh Golding pada tahun 1857, di mana ia mengamati adanya kantung urin dan selang kateter berwarna ungu. 11 Barlow dan Dickson adalah orang pertama yang melaporkan kasus PUBS dalam literatur, yaitu pada tahun 1978. 5,12,13 Mereka menemukan perubahan warna ungu pada urin pasien yang mendapatkan kateterisasi saluran kemih menetap.…”

“…Indol dikonjugasi menjadi indoksil-sulfat di hati selanjutnya diekskresikan dalam urin. 11 Bakteri urin menghasilkan enzim indoksilsulfatase, yang memecah indoksil-sulfat menjadi indoksil. Indoksil kemudian berubah menjadi indigo (biru) dan indirubin (merah).…”

“…5,7 Spesies jamur Candida albicans pernah diisolasi dari sampel urin pasien yang mengalami PUBS. 11 4. Patogenesis PUBS Beberapa hipotesis telah diajukan mengenai etiopatogenesis PUBS.…”

“…2 Campuran kedua pigmen dalam suasana urin yang alkali menghasilkan warna ungu, mengendap dan bereaksi terhadap komponen sintetis dari kateter dan kantung urin. 11,18 Kantung drainase kateter uretra plastik kadangkadang berubah menjadi ungu beberapa jam atau hari setelah kateterisasi. Semakin lama sistem drainase tersebut dipertahankan, maka semakin intens warna ungu yang timbul.…”