Unusual foreign bodies in the urethra and bladder

Sexual dysfunction associated with chronic retention of foreign bodies in the low urinary tract

We sought to evaluate the association between sexual dysfunction and chronic retention of foreign bodies in the lower urinary tract (LUT) for long-term periods (≧4 weeks) in patients seen at three medical centres between January 2015 and September 2020, followed by assessing the impact of long-term retention of a foreign body in the LUT on sexual function. Thirty-eight patients were studied in the long-term group, among whom the aetiology of the foreign bodies included sexual desire with masturbation (n = 22, 58%), sexual inquisitiveness (n = 10, 26%), dysuria (n = 3, 8%) and seeking to relieve itching (n = 3, 8%). There were various types of foreign bodies, including a string of magnetic beads (n = 13), a thermometer (n = 5), plastic electric wire (n = 5) and others (n = 15). All cases presented with sexual dysfunction and LUT symptoms. Three months after foreign body removal, sexual dysfunction symptoms were significantly improved in 22 male cases and seven female cases. We found that chronic retention of foreign bodies in the LUT causes sexual dysfunction in both men and women. The psychological effects of fear may prevent these patients from seeking medical help. Thus, education on sexual medicine and timely removal of foreign bodies is necessary to avert sexual dysfunction and urinary tract infection.

Self-insertion of an odd urethral foreign body that led to Fournier's gangrene

Self-inserted urethral foreign bodies (FBs) are rare. Neither reported case was the self-inflicted FB due to a lack of financial resources nor was either case complicated by Fournier's gangrene. We present a 54-year-old male who inserted a household pipe to relieve his urine retention. Unfortunately, the FB became stuck inside, perforated the urethra, and required perineal exploration. After it was removed, the urethra was closed over a 16F urethral catheter. The wound was complicated by severe infection and resulting Fournier's gangrene. This required an additional surgery for debridement and urine diversion. Retrospectively, it would have been better if the urethra had been left open with SP tube only. We are sharing a clinical lesson learned by the practicing urologist and surgeons. Conclusively, self-inserted FBs in the urethra may lead to a series of complications. Patients with limited financial resources need more attention and care because they may hurt themselves unintentionally.

Urethral self-inserted sewing needle in a 14-year-old boy for autoerotic stimulation

Urethral foreign bodies are rare in daily practice, especially in adolescents with no evident history of mental illness. The presentation is usually delayed and a wide variety of objects may be implicated. Treatment by minimally invasive procedures (endoscopy), if possible, is preferred to minimize bladder and urethral injuries and psychiatric evaluation is mandatory to detect an underlying mental disorder. Despite the available literature on self-inserted urethral foreign bodies; the case we report here of urethral self-insertion of a sewing needle in a 14 year-old boy for autoerotic stimulation is very rare.

Gastric banding clip in the urinary bladder

BACKGROUND AND AIM

A wide variety of foreign bodies have been found in the urinary bladder, most often due to self-introduction and autoerotism, or iatrogenically introduced during surgery in the anatomic region. We report the first case of a gastric banding clip found in the urinary bladder.

CASE PRESENTATION

We describe the case of a 33-year-old Chinese female who had previously undergone gastric banding and subsequent removal of the band. She presented with lower urinary tract symptoms which followed a diurnal pattern, and investigations revealed a portion of a gastric banding clip in the urinary bladder. There was no sign of perforation or erosion of the bladder. The clip was surgically removed and the patient recovered without complications.

DISCUSSION AND CONCLUSION

This is the first reported case of an intraperitoneal gastric banding clip migrating extraperitoneally into the urinary bladder. The use of the urinary bladder to expel foreign bodies has been documented in other vertebrates, and the mechanism by which this occurs without perforation or erosion of the urinary bladder warrants further investigation.

Acute pelvic pain: a ball pen may be a cause?

Chronic Urinary tract infection (UTI) is a common problem in women and can be seen without any significant anatomical and functional pathology. Foreign bodies within the urinary bladder are not rare and should be considered as a cause of chronic and recurrent UTI. Intravesical foreign bodies can be self inflicted, iatrogenic or migration from adjacent organs. History in these cases is often misleading and presentation of foreign body mostly becomes apparent as suprapubic pain, dysuria with or without hematuria. We present a case of self-inflicted foreign body within the bladder of a young female who presented with recurrent urinary tract infections for six months that did not respond to medical treatment.

A man with urethral polyembolokoilamania successfully treated with electroconvulsive therapy

Polyembolokoilamania is the act of inserting foreign objects into bodily orifices and can be classified as a paraphilia if done for sexual pleasure. Although problematic sexual behaviors are common in dementia, the majority of case reports of urethral polyembolokoilamania in the elderly have occurred in the absence of dementia or cognitive impairment. Little empirical evidence exists for managing problematic sexual behaviors in the elderly and in dementia. Most evidence in the form of case reports demonstrates that behavioral, environmental, and pharmacological interventions can be effective. In this case report, we describe the management of sexually disinhibited behavior in the form of polyembolokoilamania in a 67-year-old man suffering from treatment-resistant depression, obsessive compulsive disorder, and early signs of frontotemporal dementia. The successful treatment included a course of electroconvulsive therapy.

Retained self-inserted foreign body into the urethra associated with sequela urethral stenosis: a case report

Introduction

Self-insertion of foreign bodies into the urethra represents a heterogeneous group of cases concerning a wide variety of objects and involving multiple procedures and surgical techniques.

Case presentation

We report a case of self-insertion of an electric cable into the urethra by a 36-year-old Caucasian man for erotic reasons. The patient, who has an ambiguous history of self-inflicted penile strangulation in childhood and self-insertion of foreign bodies into the urethra in recent years but no psychiatric history, presented to the emergency department to remove the object introduced one week previously. He was - strangely - asymptomatic and presented neither dysuria nor urinary incontinence or hematuria. A physical examination revealed a penile scar corresponding to the strangulation and a palpable hard, thin mass in the perineal urethra. The biologic findings were normal. Plain film of the urinary tract showed a hollow tubular object, whose size and shape corresponded to those of the urethra. Rigid cystoscopy was performed, which revealed urethral stricture at the projection of the scar. Laborious urethrotomy was performed before reaching the 25cm long cable, which was found in the urethra and removed with difficulty due to stenosis.

Conclusions

We encountered a particular case combining a self-introduced foreign body in the urethra and the sequelae of such manipulations, which is urethral stricture. We succeeded in treating both by endoscopy, which is not always possible in this situation.

Bedside ultrasound in workup of self-inserted headset cable into the penile urethra and incidentally discovered intravesical foreign body

There are multiple reports of foreign bodies inserted into the lower urinary tract. We report the case of an incidentally discovered foreign body identified within the bladder in a male patient presenting with a radio antenna protruding from the urethra attached to a head set. On workup patient was found to have an additional foreign body within the bladder and second radiolucent object within the urethra. This case demonstrates the importance of complete evaluation of the lower urinary tract during workup of inserted foreign bodies and the value of the bedside ultrasound as a diagnostic tool in distinguishing between rectal and genitourinary tract insertion.

Successful Removal of an Intravesical Electrical Wire Cable

A few previous reports have described cases wherein electrical wire cables were inserted into the male urethra and bladder. Electrical wire cables are available at home and are easy to insert. However, after they coil in the patient's bladder, they are difficult to remove. In February 2013, a 30-year-old man presented to the emergency room of SMG-SNU Boramae Medical Center with a urethral foreign body. He had inserted an electrical wire cable into his urethra for the purpose of masturbation, despite having a regular sex partner and no underlying disease. A kidney-ureter-bladder radiography showed a tangled wire in his bladder and urethra. On the next day, we tried to remove the wire cystoscopically, but this proved to be impossible because of complex coiling and the slippery surface of the wire. A Pfannenstiel incision was made to remove the foreign body. No postoperative complications were noted.

Open removal as a first-line treatment of magnetic intravesical foreign bodies

Intravesical foreign bodies are an uncommon, but significant, cause of urologic consultation. We present 3 patients who all inserted magnetic beads per urethra into the urinary bladder, which subsequently became retained. Endoscopic attempts were unsuccessfully tried in the first 2 cases, necessitating open cystotomy to remove the beads. The third went straight to open removal. Given the failure of minimally invasive techniques, we believe that open removal should be the first-line treatment for these types of foreign bodies.

[Foreign bodies in urinary bladder: a clinical case]

OBJECTIVES

A pencil in the urinary bladder is an unusual problem for urologists. We present a case in a 44-year-old female with an eyeliner pencil self-introduced into the urethra.

MATERIALS AND METHODS

The patient was referred to us with a recent history of "ingestion of foreign body". The clinical presentation, radiologic data, and treatment were reported.

RESULTS

The patient had a pencil placed sideways in the urinary bladder, with focal perforation of the left wall. A cystoscopy was performed and the pencil was removed at the same time by using grasping forceps and hydraulic overdistention of the urinary bladder.

CONCLUSIONS

Bladder is the most common location of foreign bodies of the urogenital tract, almost always due to self-insertion into the urethra for the purpose of masturbation or as a result of non-inhibited or altered behavior due to psychiatric diseases, or to the influence of drugs. Most patients were too ashamed to admit they had inserted or applied any object and usually presented when a complication had occurred such as difficulty in voiding, hematuria, pain or swelling, extravasations or abscess formation. The treatment can be endoscopic, and it depends on the type of the foreign object and the operator's skills.

Intravesical foreign bodies: a case report and a review of the literature

Aim

We report a case of intravesical polyvinyl-coated electric wire in the urinary bladder.

Case report

A 34-year-old man presented in our clinic with irritative lower urinary tract symptoms. Three weeks earlier he had seen and felt a wire in his urethra of which he was unaware of the origin. Radiologic evaluation revealed an electric wire completely coiled up in the urinary bladder. It was removed through a suprapubic cystotomy.

Discussion

Patients are usually too ashamed to admit the cause of an intravesical foreign body, which is often sexual or erotic in origin. Radiologic evaluation usually reveals the nature and size of the foreign body in the bladder of patients evaluated for recurrent urinary tract infection. Open surgery or an endoscopic approach may be used for their extraction.

Successful removal of a telephone cable, a foreign body through the urethra into the bladder: a case report

The variety of foreign bodies inserted into or externally attached to the genitourinary tract defies imagination and includes all types of objects. The frequency of such cases renders these an important addition to the diseases of the genitourinary organs. The most common motive associated with the insertion of foreign bodies into the genitourinary tract is sexual or erotic in nature. In adults this is commonly caused by the insertion of objects used for masturbation and is frequently associated with mental health disorders. We report a case of insertion of telephone cable wire into the urethra. Our case highlights the importance of good history, clinical examination, relevant radiological investigation and simple measures to solve the problem.

[Urethral trauma]

Urethral lesions may be caused by blunt or penetrating objects in the course of accidents, or can be iatrogenic resulting from invasive measures such as catheterization or other major surgical measures (prostatectomy or sling operations for continence). They can also be caused by foreign bodies deliberately introduced into the urethra. Injuries may primarily affect the anterior or posterior urethra. Urethral reconstruction presupposes knowledge of the precise anatomy of the pelvic region. The surgical techniques used and the timing of reconstructive procedures will depend on the cause and nature of the urethral injury. A definitive surgical intervention in most cases of lesions resulting from accidents is not generally recommended, especially when the lesion is in the posterior urethra. A treatment algorithm should prevent post-surgical complications such as incontinence, impotence, recurring urinary tract infections, etc., necessitating multiple operations, and assure an adequate quality of life. Diagnostic clarification of the exact nature of urethral injuries requires high quality imaging studies by specialists in the field.

Chronic perforation of the urinary bladder by self-inserted foreign body

We report on a 14-year-old girl with pyelonephritis, secondary to a foreign body, in her urinary bladder. A self-inserted pencil led to stone formation and bladder perforation at two sites. Eighteen months after insertion, the pencil was removed by suprapubic cystotomy.

[Foreign bodies in the urethra and bladder: our experience]

We report the urethra and bladder foreign bodies seen in our department from 1976 to September 2004. We review the kind of the foreign bodies, the psychological profile of the patient, the clinical findings, diagnosis and treatment. We also review the literature about this matter.

Self-inflicted male urethral foreign body insertion: endoscopic management and complications

OBJECTIVE

To evaluate the cause, diagnosis, management and complications of self-inserted urethral foreign bodies in men, reviewing a 17-year experience.

PATIENTS AND METHODS

From November 1986 to January 2004, 17 men were treated for self-inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications.

RESULTS

In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton-tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body.

CONCLUSION

Self-inflicted urethral foreign-body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow-up, albeit difficult in these patients, is desirable.

A foreign body self-inserted via the urethra into the bladder: pocket battery

A 37-year-old male patient who had intense discomfort due to dysuria, pollacuria, was examined and a foreign body was determined in the bladder. This foreign body was a type of pocket battery self inserted compulsively into the bladder by the patient and this is the first published report to our knowledge.

[Stones and foreign bodies of the urethra]

Foreign bodies in the bladder and urethra have been already largely described either by their nature itself as well as by the circumstances of their introduction. If their presence often reveals dubious psychiatric behaviours, one must also evoke possible accidental introductions during transvesical surgery or migration from spaces adjacent to the bladder. The treatment of those foreign bodies can be sorted out through endoscopy or surgical approach.

[Urethro-vesical foreign bodies]

We report the case of a squizoid 45 year old man who presented an acute urinary retention and had several foreign bodies in the urethra and bladder.

Retention of urethrovesical foreign bodies: case report and literature review

Insertion of foreign bodies into the urethram to obtain sexual pleasure may be complicated by their passage into the urinary bladder along with an inability for the patient to recover the foreign body. We present such a case, review the relevant literature, and discuss Emergency Department (ED) diagnosis and management.

Clinical management of foreign bodies of the genitourinary tract

PURPOSE

The variety of foreign bodies inserted into or externally attached to the genitourinary tract defies imagination and includes all types of objects. The frequency of such cases renders these objects an important addition to the diseases of the urinary organs.

MATERIALS AND METHODS

We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized.

RESULTS

Our review encompassed approximately 800 single case reports on foreign bodies in the English world literature published between 1755 and 1999. We structured the range of introduced objects, by referring to origin and material as well as the genitourinary organs involved. Furthermore, we noted symptomatology and diagnoses, including psychological involvement, as well as possible treatment options.

CONCLUSIONS

The most common motive associated with foreign bodies of the genitourinary tract is sexual or erotic in nature. The most suitable method of removing a urethral foreign body depends on the size and mobility of the object applied to the genitourinary tract. When possible, endoscopic and minimal invasive techniques of removal should be used. However, surgical retrieval of a foreign body may be required, particularly when there is a severe associated inflammatory reaction.