CATHETERIZATION of the urinary bladder is indispensable in many clinical situations even though this procedure, and particularly the use of the indwelling catheter, has been increasingly incriminated as a cause of cystitis, pyelonephritis, and fatal bacteremia. Studies directed toward uncovering the mechanism by which these complications and their sequelae are produced have led to a vast literature.1-4
While the scope of the problem has been delineated, and the routes by which bacteria gain access to the catheterized urinary bladder have been charted, a specific anatomic lesion that might play a role in the development of bacteruria and bacteremia has not been identified.
I found a symmetrical, round, punched-out perforation in the dome of the urinary bladder to have been the cause of a generalized peritonitis in an autopsy performed several years ago. The etiology of the lesion went unexplained until an ulcer of the same configuration uncovered at the