Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

Latex Allergy Causing Ureteral Obstruction in a Boy with Epispadias

A boy had epispadias repair and bladder neck reconstruction plus bilateral reimplants. After surgery he had a latex Malekot suprapubic tube. He began to have back pain and was shown to have severe hydroureteronephrosis even when the catheter was draining the bladder continuously (Figure 1). The bladder became very thick-walled and its capacity began to decrease. The wall was very irregular (Figure 2). Cystoscopy showed severe bullous edema. The edema was so severe that the ureteral orifices could not be identified. The latex tube was changed to a silastic Foley catheter suprapubic tube and the bullous edema gradually subsided as did the hydroureteronephrosis. This represents UV obstruction from bullous edema of the bladder mucosa from latex alergy.