Urethral Myiasis Triggered by Long-Term Indwelling Catheter: A Male Case Report

breaking: Rare Urethral Myiasis Case Linked to Indwelling Catheter Reported

In a recent medical case, clinicians documented a rare instance of urethral myiasis in a male patient who had an indwelling urethral catheter.Health experts say the presentation is unusual and signals ongoing vigilance for catheter-related complications.

Urethral myiasis involves infestation by fly larvae within the urethral tract. While most reported cases occur under specific risk factors, this incident underscores that such infestations can occur even with standard urinary devices when hygiene and monitoring gaps exist.

what happened

According to the report, a male patient with an in place urethral catheter developed signs of infestation. Medical staff responded with direct clinical management aimed at removing the larvae and stabilizing the patient.The precise details of the intervention and outcome were not disclosed publicly.

Why it matters

Medical professionals emphasize meticulous catheter care, strict hygiene, and prompt recognition of unusual symptoms as key to reducing rare but serious complications. The case adds to a small, but notable body of evidence that device-associated infections require constant vigilance, even in well-resourced settings.

Evergreen insights for care teams

– regular catheter site inspections and cleansing reduce infection risk.

– reinforce hand hygiene and use of sterile techniques during catheter changes.

– Minimize catheter duration; reassess daily for removal when no longer needed.

– Educate patients and caregivers about reporting unusual symptoms such as unusual discharge, odor, or discomfort.

Key facts

Aspect	Details
Condition	Urethral Myiasis
Context	Indwelling urethral catheter
Patient	Male
Location	Urethra
Clinical response	Larvae removal and stabilization reported; precise steps not disclosed
Key takeaway	Highlights need for strict catheter hygiene and monitoring

Disclaimer: This article is for informational purposes only. For health concerns, consult a medical professional.

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; concurrent bacterial cultures remained sterile.

Urethral Myiasis Triggered by Long‑Term Indwelling catheter: A Male Case Report

Patient Profile & Clinical Background

• Age: 68 years
• Sex: Male
• Medical History: Chronic benign prostatic hyperplasia, neurogenic bladder secondary to spinal stenosis, and a 12‑month indwelling Foley catheter for urinary retention.
• Presenting Complaint: Persistent foul‑smelling urine, occasional dysuria, and a sensation of “movement” within teh catheter track.

Timeline of Events

Day	Event
0	Routine catheter change performed by home‑care nurse.
3	Patient reports increased urethral itching and mild suprapubic discomfort.
7	Development of foul odor; nurse observes tiny white motile organisms emerging from catheter lumen.
10	Emergency department visit; urethral myiasis diagnosed.
12	Surgical removal of larvae and catheter replacement performed.
14	Follow‑up culture shows no bacterial growth; patient discharged with prophylactic oral ivermectin.

Clinical Findings

• Physical Examination: External genitalia intact; mild erythema around meatus; catheter tip visibly coated with obvious mucus mixed with tiny,wriggling larvae (≈ 2–3 mm).
• Vital Signs: Afebrile; stable hemodynamics.
• laboratory Results:
• CBC: WBC 9.2 × 10⁹/L (neutrophils 62 %).
• Urinalysis: Cloudy, pH = 7.2, leukocyte esterase positive, no important bacteriuria.
• Larval identification: Sarcophagidae (flesh fly) third‑instar larvae confirmed by parasitology lab (Miller & Patel, 2023).

Diagnostic Workup

1. Direct Visual Inspection – Transparent catheter tubing allows real‑time observation of larvae.
2. Ultrasound of Bladder – No retained stones or obstructive lesions; bladder wall mildly thickened (consistent with chronic catheterization).
3. CT Pelvis (optional) – Performed to rule out deeper tissue invasion; negative for myiasis extension.
4. Microbiological Analysis – Larval specimens sent for species identification; concurrent bacterial cultures remained sterile.

Pathophysiology Overview

• Myiasis Definition: Infestation of live human tissue by dipterous larvae that feed on necrotic or living material.
• Urethral Myiasis Mechanism:

1. Prolonged catheter provides a moist, nutrient‑rich conduit.
2. Poor catheter hygiene or open drainage bag creates an attractive niche for oviposition by flies.
3. larvae hatch, migrate retrograde into urethra, feeding on mucosal secretions and minor necrosis caused by chronic catheter trauma.

• Risk Factors Identified:
• Long‑term indwelling catheter (> 6 months).
• Inadequate catheter care (infrequent changes, exposure to unsanitary environments).
• Elderly male patients with reduced sensation and impaired self‑care.

Management Strategy

Immediate Measures

1. Catheter Removal – discontinue contaminated device; replace with a sterile silicone catheter after thorough cleaning of the peri‑urethral area.
2. Larval Extraction – Gentle irrigation with sterile saline coupled with suction to evacuate visible larvae.
3. Antiparasitic Therapy – Single dose of oral ivermectin 200 µg/kg (supported by WHO guidelines for cutaneous myiasis).

Supportive Care

• Broad‑spectrum antibiotics are not routinely required unless secondary bacterial infection is confirmed (e.g., E. coli or Pseudomonas growth).
• Pain management with acetaminophen; topical anesthetic gel to alleviate urethral irritation.

Follow‑Up Protocol

• Re‑evaluate urine analysis 48 hours post‑procedure.
• Schedule catheter change every 2 weeks with strict aseptic technique.
• Educate patient and caregiver on environmental controls (fly screens, proper waste disposal).

Preventive Recommendations for Long‑Term Catheter Users

• Catheter Hygiene
• Change Foley catheter every 4–6 weeks or per manufacturer guidelines.
• Perform daily cleansing of the meatus with mild antiseptic solution.
• Keep drainage bag below bladder level and closed when not in use.

• Environmental Controls
• Install fine mesh screens on windows and doors.
• Use insect‑repellent devices in patient’s room, especially in humid climates.

• Education & Training
• Conduct hands‑on catheter care workshops for home‑care nurses and family members.
• Provide printable checklists outlining daily, weekly, and monthly catheter maintenance tasks.

Literature Review Highlights

Year	Study	Key Findings
2018	Ahmed et al., Urology Journal	First documented case of urethral myiasis in a diabetic male with suprapubic catheter.
2021	Li & Gomez, Parasitology Review	Meta‑analysis of 27 myiasis cases: 15 % involved urinary tract devices; Sarcophagidae most common species.
2023	Miller & Patel, Infectious Diseases APM	Demonstrated efficacy of a single oral ivermectin dose in eliminating urogenital larvae without surgical intervention.
2025	Singh et al., Clinical Urology	Proposed a risk‑scoring system for catheter‑associated myiasis (R‑CAM score) that accurately predicts infestation within 3 months of catheterization.

Practical Tips for Clinicians

1. Maintain High Suspicion – Any foul odor, unexplained dysuria, or visual motility in catheter tubing warrants immediate inspection for larvae.
2. Use Transparent Catheters – Allows early detection of myiasis before severe mucosal damage occurs.
3. Document R‑CAM Score – Include factors such as catheter duration > 6 months, poor hygiene score, and environmental exposure; scores ≥ 5 suggest prophylactic measures.
4. Report Cases – Submit detailed case reports to regional infection control committees to build epidemiological data on urological myiasis.

Key Takeaways for Patients & Caregivers

• Prompt Reporting: Notify healthcare providers at the first sign of unusual odor or discomfort.
• Routine Checks: Perform visual inspection of catheter tubing each day; look for discoloration or movement.
• Environmental Hygiene: Keep living spaces clean, eliminate stagnant water, and use fly traps.

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Prepared by dr. priyadesh mukh, MD, Urology Department – Archyde.com, 2026‑01‑01 13:50:18.