Purple Urine Bag Syndrome in a Young Adult With Neurogenic Bladder Secondary to Partial Caudal Regression Syndrome - A Case Report

Sep 28, 2026

Purple urine bag syndrome (PUBS) is a rare, benign condition linked to long-term urinary catheterization, driven by bacterial metabolism of urinary indoles into blue and red pigments. A 22-year-old woman with a neurogenic bladder due to partial caudal regression syndrome developed PUBS, noted by purple discoloration of the catheter bag. Her management focused on reassurance and catheter hygiene, while multidisciplinary review did not pursue permanent surgery due to nonviable anatomy or patient preferences. The report emphasizes recognizing PUBS and using conservative care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Case Presentation

Management and Multidisciplinary Review

How to Cite

Review began 10/30/2025 Review ended 11/19/2025 Published 11/30/2025 © Copyright 2025 Seth et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98197 Open Access Case Report Purple Urine Bag Syndrome in a Young Adult With Neurogenic Bladder Secondary to Partial Caudal Regression Syndrome: A Case Report Suryakanta Seth 1, Abhimanyu Vasudeva 2, Dharmendra K. Pipal 3, Ravi Gupta 4, Gaurav Gupta 3 1. Anatomy, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND 2. Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND 3. General Surgery, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND 4. Surgery, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND Corresponding author: Abhimanyu Vasudeva, [abhimanyu.vmmc@gmail.com](abhimanyu.vmmc@gmail.com) Abstract Purple urine bag syndrome (PUBS) is a rare, benign condition associated with long-term urinary catheterization, caused by bacterial metabolism of urinary indoles into blue and red pigments. We present the case of a 22-year-old female with a neurogenic bladder secondary to partial caudal regression syndrome who developed PUBS. The patient presented with a history of purple discoloration of her catheter bag. She had been on continuous bladder drainage since age three, with routine catheter changes every two weeks. Management involved patient reassurance and emphasis on catheter hygiene. A permanent surgical solution for her underlying neurogenic bladder was not pursued after a multidisciplinary review concluded that available options were either anatomically nonviable or unacceptable to the patient. This case highlights the importance of recognizing PUBS to alleviate patient anxiety, provides a clear rationale for conservative management, and underscores the challenges of managing chronic bladder dysfunction in patients with complex congenital anomalies. The patient provided broad written informed consent for publication. Categories: General Surgery, Physical Medicine & Rehabilitation, Anatomy Keywords: case report, caudal regression syndrome, long-term catheterization, neurogenic bladder, purple urine bag syndrome Introduction Purple urine bag syndrome (PUBS) is a rare and visually striking condition characterized by purple discoloration of urine in catheter drainage systems. It is typically associated with long-term catheterization, female sex, and urinary tract colonization by bacteria such as Providencia stuartii, Klebsiella pneumoniae, and Escherichia coli [1,2] . Recognition is important because PUBS is generally benign, though it can cause significant concern for patients and caregivers [1] . While most reported cases occur in elderly, institutionalized patients, PUBS is an important diagnostic consideration in any chronically catheterized individual, including younger patients with congenital neurogenic bladder. Caudal regression syndrome (CRS) is an uncommon congenital disorder characterized by partial or complete absence or malformation of the caudal vertebrae, frequently accompanied by spinal cord anomalies, with an estimated incidence of 0 .1 to 0.25 per 10,000 live births [3,4] . The urinary bladder originates from the endodermal urogenital sinus around the fourth week of gestation, following the division of the cloaca by the urogenital septum. The upper portion of the sinus forms the bladder, while its distal part develops into the urethra. Incorporation of the mesonephric ducts contributes to the formation of the trigone, and the ureteric buds eventually acquire separate openings into the bladder [5] . Functionally, bladder activity depends on coordinated input from parasympathetic (S2-S4), sympathetic (T 10-L2),

FAQs

What causes purple urine bag syndrome (PUBS) in catheterized patients?

PUBS is caused by bacterial metabolism of urinary indoles into blue and red pigments, producing purple discoloration in catheter drainage systems.

How was PUBS managed in the reported case?

Management centered on patient reassurance and emphasizing catheter hygiene rather than immediate escalation to definitive surgery.

Why was a permanent surgical solution not pursued for the underlying condition?

A multidisciplinary review concluded that available surgical options were either anatomically nonviable or unacceptable to the patient.

Sep 28, 2026

Uploaded by Nguyễn Văn Học