The guide wire is a very useful medical device that helps make the cannulation of blood vessels or hollow structures safer.
However, guide wires themselves can be a source of complication, such as with perforation and bleeding. Kinking of the guide wire is another complication that is less described. We postulate the sequence of events that precede kinking and discuss the ways to avoid them.
A 60-year-old man underwent optical urethrotomy for a bulbar urethral stricture. A guide wire was passed into an existing suprapubic catheter (SPC) track to facilitate the passage of a flexible cystoscope. This was performed to examine the proximal extent of the urethral stricture. At the end of the procedure, there was unexpected resistance when withdrawing the guide wire from the bladder. Cystoscopic examination via the SPC track eased the guide wire out eventually. It was found that a kink in the guide wire had prevented its smooth retrieval. The cause of this complication was likely due to looping of the guide wire within the bladder. The loop then resulted in the guide wire getting kinked. In order to prevent kinking, one must avoid looping. Looping occurs when an excessive length of guide wire is forced into a confined space. Therefore, it is important to stop advancing the guide wire when resistance is felt. Another method to avert this problem is to first estimate the length of guide wire that would pass into the space without it curling back. Then pass the guide wire only up to the point where it is deemed adequate. By practicing such precautions, the chances of running into a complication, such as guide wire kinking, can be reduced significantly.
KEYWORDS: guide wire, complications, endourology
CORRESPONDENCE: Guan Hee Tan, MBBS, MRCS, MS, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia ( )
CITATION: UroToday Int J. 2012 December;5(6):art 65.
DOI: http://dx.doi.org/10.3834/uij.1944-5784.2012.12.10
