Skip to main content Skip to main navigation menu Skip to site footer

Purple Urinary Bag Syndrome (PUBS) in Benign Prostate Hyperplasia (BPH) with long-term indwelling urinary catheter use: a case report and literature review


Background: PUBS is one of the clinical manifestations of urinary tract infection. This condition often leads patients, patients’ families, and medical workers to worrisome. Metabolism of tryptophan and infection of sulfatase and phosphatase - producing bacteria is the most acceptable pathogenesis explaining PUBS. Many risk factors are underlying this condition, including long-term use of indwelling urinary catheters, constipation, dementia, chronic kidney disease, and bedridden patients. This case study aims to evaluate the recent treatment of supporting factors in treating the underlying urinary infection.

Case Presentation: We presented a case report of a 67year-old man with Benign Prostate Hyperplasia (BPH) and long-term use of indwelling urinary catheter who complained of purple discoloration of urine a day prior to Transurethral Resection of the Prostate (TURP) surgery. The patient complained of no fever and pain while urinating and having no history of the same complaint and other diseases. In addition, the patient has diagnosed with BPH and Urinary Tract Infection. The administration of Cefazolin 2 grams dosage was given before the TURP procedure, and the following procedure continued.

Conclusion: PUBS is a rare clinical course alarming the urinary tract infection. Appropriate treatment by Cefazolin 2 grams dosage following by TURP shows a favorable outcome in this case study.


  1. Traynor BP, Pomeroy E, Niall D. Purple urine bag syndrome: a case report and review of the literature. Oxf Med Case Reports. 2017;2017(11):omx059.
  2. Hadano Y, Shimizu T, Takada S, Inoue T, Sorano S. An update on purple urine bag syndrome. Int J Gen Med. 2012;5:707-710.
  3. Kalsi DS, Ward J, Lee R, Handa A. Purple Urine Bag Syndrome: A Rare Spot Diagnosis. Dis Markers. 2017;2017:9131872.
  4. Sabanis N, Paschou E, Papanikolaou P, Zagkotsis G. Purple Urine Bag Syndrome: More Than Eyes Can See. Curr Urol. 2019;13(3):125-132.
  5. Khan F, Chaudhry MA, Qureshi N, Cowley B. Purple urine bag syndrome: an alarming hue? A brief review of the literature. Int J Nephrol. 2011;2011:419213.
  6. Kumar D, Donga N, Macwan R. Purple Urine Bag Syndrome: A Scary but Easily Manageable Condition in a Patient with Prolonged indwelling Urinary Catheter. Indian J Palliat Care. 2018;24(4):534-536.
  7. Goyal A, Garg V, Jindal J. Purple Urine Bag Syndrome: Series of Nine Cases and Review of Literature. Journal of Clinical and Diagnostic Research. 2018;12(11): PR01-PR03
  8. Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep. 2018;8(3):249-256.
  9. Worku DA. Purple urine bag syndrome: An unusual but important manifestation of urinary tract infection. Case report and literature review. SAGE Open Med Case Rep. 2019;7:2050313X18823105.
  10. Dealler SF, Belfield PW, Bedford M, Whitley AJ, Mulley GP. Purple urine bags. J Urol. 1989;142(3):769-770.
  11. Mohamad Z, Chong VH. Purple urine bag: think of urinary tract infection. Am J Emerg Med. 2013;31(1):265.e5-6.
  12. Garcia JL, Lopez MG, Bernabeu AP, Cepeda JM, Wikman-Jorgensen P. Purple Urine Bag Syndrome: A Systematic Review with Meta-analysis. European Geriatric Medicine. 2017;8(3):221-227
  13. Dealler SF, Hawkey PM, Millar MR. Enzymatic degradation of urinary indoxyl sulfate by Providencia stuartii and Klebsiella pneumoniae causes the purple urine bag syndrome. J Clin Microbiol. 1988;26(10):2152-2156.
  14. Yaqub S, Mohkum S, Mukhtar KN. Purple urine bag syndrome: A case report and review of literature. Indian J Nephrol. 2013;23(2):140-142.
  15. Delgado G, Martínez-Reséndez M, Camacho-Ortiz A. Purple urine bag syndrome in end-stage chronic kidney disease. J Bras Nefrol. 2014;36(4):542-544.
  16. Shiao CC, Weng CY, Chuang JC, Huang MS, Chen ZY. Purple urine bag syndrome: a community-based study and literature review. Nephrology (Carlton). 2008;13(7):554-559.
  17. Chung SD, Liao CH, Sun HD. Purple urine bag syndrome with acidic urine. Int J Infect Dis. 2008;12(5):526-527.
  18. Tasi YM, Huang MS, Yang CJ, Yeh SM, Liu CC. Purple urine bag syndrome, not always a benign process. Am J Emerg Med. 2009;27(7):895-897.

How to Cite

Wiratma, M. K. Y., Octavia, P. D., & Hutauruk, E. S. (2020). Purple Urinary Bag Syndrome (PUBS) in Benign Prostate Hyperplasia (BPH) with long-term indwelling urinary catheter use: a case report and literature review. Intisari Sains Medis, 11(3), 1467–1470.




Search Panel

Made Kresna Yudhistira Wiratma
Google Scholar
ISM Journal

Putu Dewi Octavia
Google Scholar
ISM Journal

Eric Sebastian Hutauruk
Google Scholar
ISM Journal