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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 66-68

Self-inflicted urethral and vesical foreign bodies – Case report


Department of Urology, Grant Government Medical College and Sir JJ Hospital, Mumbai, Maharashtra, India

Date of Submission06-Aug-2020
Date of Acceptance19-Oct-2020
Date of Web Publication20-May-2021

Correspondence Address:
Dr. Venkat A Gite
Swastik Building No 4, House No 6 - Ist Floor, Grant Medical College and Sir JJ Hospital, Mumbai - 400 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_37_20

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  Abstract 


Foreign bodies in the lower urinary tract are rare with self-infliction for sexual gratification as the commonest reason. Presenting complaints are lower urinary tract symptoms, abdominal pain, and haematuria. We report two cases of self-inflicted foreign bodies in the lower urinary tract of adult male patients; one by an electrical wire and another by Bengal grams. Bengal gram as the foreign body has never been reported previously. X-ray, ultrasound, and computed tomography of the KUB region help to confirm the diagnosis. The primary goals of treatment are safe removal of foreign bodies, avoiding iatrogenic injuries to the lower urinary tract, and preservation of the sexual function. Endoscopic management is the commonest procedure performed and described in such cases. We were able to manage both cases endoscopically. Psychiatric consultation and appropriate counselling should be given to prevent further repetitions of such acts in the future.

Keywords: Bengal gram, case report, electrical wire, foreign body, urethra, urinary bladder


How to cite this article:
Nikose J, Agrawal M, Gite VA, Sankapal P. Self-inflicted urethral and vesical foreign bodies – Case report. Arch Int Surg 2020;10:66-8

How to cite this URL:
Nikose J, Agrawal M, Gite VA, Sankapal P. Self-inflicted urethral and vesical foreign bodies – Case report. Arch Int Surg [serial online] 2020 [cited 2021 Jun 14];10:66-8. Available from: https://www.archintsurg.org/text.asp?2020/10/2/66/316492




  Introduction Top


Foreign bodies in the urethra and the urinary bladder are uncommon.[1],[2] Self-infliction for sexual gratification is the commonest reason.[3],[4],[5],[6] Common presenting complaints are lower urinary tract symptoms, abdominal pain, and haematuria.[1],[2],[6] Treatment is careful removal while avoiding trauma to the urethra and bladder.[6],[7]

We report two such cases. In one of the cases, we found 'Bengal grams', which is unreported previously.


  Case Reports Top


Case 1

A 36-year-old male presented to the emergency department with complaints of abdominal pain, straining, thinning of the urinary stream, and dysuria for one day. One day ago, while masturbating, he inserted around seven to eight Bengal grams into his penis.

On examination, the bladder was not palpable. External genitalia and meatus were normal without visible foreign body. On palpation four non-tender, nodular swellings with irregular surface, each of size approximately one cm were palpable in the urethra. X-ray of Kidney Ureter and Bladder (KUB) did not reveal any radio-opaque shadow. Ultrasonography revealed multiple echogenic lesions with acoustic shadowing in the urethra. Consent was obtained for the emergency surgical intervention.

Under spinal anaesthesia cystourethroscopy revealed the presence of multiple (seven) swollen Bengal grams in the penile and bulbar urethra. The pressure of the irrigation fluid resulted in their proximal migration into the bladder [Figure 1]a. Cystoscopy grasping forceps were used and grams were removed intact. Due to friability few grams got broken which were removed successfully by giving bladder wash [Figure 1]b.
Figure 1: (a) Cystoscopy view showing the presence of multiple swollen Bengal grams inside the urinary bladder. (b) Removed Bengal grams – intact and broken pieces

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Case 2

A 25-year-old male presented to the emergency department with only severe dysuria as the presenting complaint. Three days back while masturbating he had introduced an electrical wire of approximately ten cm in length into his penis and he failed to pull it out.

On examination, external genitalia and meatus were normal without visible or palpable foreign body. The bladder was not palpable. X-ray KUB showed a faint radio-opaque shadow of the foreign body [Figure 2]a. Three dimensional (3D) reconstructed images on non-contrast computerized tomography (NCCT) revealed a single curved wire of length 12 cm and 2.2 mm behind the pubic symphysis (bulbar urethra) mimicking broken DJ stent [Figure 2]b.
Figure 2: (a) X-Ray-KUB showing the faint radio-opaque shadow of the foreign body with proximal coiled end in the bladder region (white arrow) and the distal end in the urethra (black arrow). (b) 3D-reconstructed image of the computed tomography showing single curved wire behind the pubic symphysis mimicking a broken DJ stent

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Consent was obtained for the emergency surgical intervention. Under spinal anaesthesia on cystourethroscopy, there was evidence of single electrical wire (no knots) in the bulbar urethra extending into the bladder. Cystoscopy grasping forceps were used to deliver the wire out in one piece [Figure 3]a [Figure 3]b [Figure 3]c.
Figure 3: (a) Cystoscopy view showing an electrical wire inside the urinary bladder. (b) Cystoscopy view – while grasping the copper end of the electrical wire using cystoscopy grasping forceps. (c) Wire after retrieval from the urinary bladder

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In both the cases, on re-inspection, there were no remnant of foreign bodies or mucosal erosions. 14 Fr per urethral catheter was placed which was removed on the post-operative day one. Both patients voided well and were discharged. Both the cases had presented late fearing embarrassment. Although pre-operative psychiatric evaluation did not reveal any major underlying disorder nonetheless, both patients underwent psychiatric counselling in the post-operative period. At three months' follow up, there were no urinary or sexual complaints.


  Discussion Top


The most common motive behind foreign bodies inside the lower urinary tract is sexual in nature. Other reasons are iatrogenic, accidental insertion, sexual assault, and migration from other organs.[3],[4],[5],[6] In our study, both cases were self-inflicted for sexual gratification. Some of the reported foreign bodies inside the urethra and bladder are needles, pencils, pens, wires, pins, toothbrushes, batteries, kidney beans, thermometers, toys, tampons, pessaries, etc.[2],[3],[5],[6],[7] However, there are no previously reported cases of Bengal gram.

The presentation in such cases is delayed due to guilt and embarrassment, as in our cases.[1],[2],[5],[6],[8] Patients usually present with dysuria, lower abdominal pain, frequency, urgency, weak stream, acute urinary retention, incontinence, haematuria, or asymptomatic.[1],[2],[6],[7]

Detailed history and examination give an idea about the number, shape, size, and location of the foreign body. X-ray and ultrasound of the KUB region help in the diagnosis.[3],[5],[6] Radiolucent foreign bodies are better visualised on NCCT-KUB.[1] In case two of our study, 3D reconstructed CT images gave us clear idea about the location and orientation of the foreign body.

The primary treatment goals are safe removal of foreign bodies, avoiding injuries to the lower urinary tract, and preservation of the sexual function.[6],[7] When the foreign body is visible through the external urethral meatus, one attempt of gentle traction may be applied to deliver them out but use of excessive force may lead to damage to the lower urinary tract.[1],[2] In both of our cases, foreign bodies were not visible through the external meatus so we resorted to the endoscopic technique. The commonest procedure described for foreign body removal is endoscopic retrieval which may require instruments like grasping forceps, stone baskets, and snares.[1],[5],[9] Post retrieval of the foreign body out of the body, cystourethroscopy must be done to rule out associated injuries to the lower urinary tract and ensure complete removal of the foreign bodies. Other procedures like meatotomy, internal or external urethrotomy, or suprapubic cystostomy are needed in case of failure or difficulty during endoscopic procedure.[4],[6],[7]

Complications may occur because of the long-standing foreign bodies like urinary tract infections, urethritis, stone formation, and urosepsis. Thus, perioperative broad-spectrum antibiotics must be used as inserted foreign objects are unsterile.[1],[4],[5],[8] Iatrogenic injuries while removing or manipulating the foreign body can result in urethral tear and strictures.[5]

There have been theories that have tried to highlight the underlying psychological reasons explaining such behaviours. According to Kenney's theory, the initiating event is the coincidentally discovered pleasurable stimulation of the urethra, followed by the repetition of this action with objects of unknown danger, driven by a psychological predisposition to sexual gratification.[10] Thus, psychiatric consultation should be done, and appropriate treatment/counselling should be given to prevent further repetitions of such acts in the future.[1],[2],[8],[10] In our study, both cases underwent appropriate psychiatric counselling.


  Conclusion Top


Sexual gratification remains one of the commonest motives behind the foreign bodies in the lower urinary tract. We describe previously unreported Bengal gram as the self-inflicted foreign body inside the urethra and urinary bladder.

Endoscopic interventions can safely remove the small objects from the lower urinary tract. Appropriate psychiatric counselling must be provided to avoid the repetition of such acts in the future.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgement

None

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rahman NU, Elliott SP, McAninch JW. Self-inflicted male urethral foreign body insertion: Endoscopic management and complications. BJU Int 2004;94:1051-3.  Back to cited text no. 1
    
2.
Hegde AV, Choubey S, Kanagali RS, Pipara G, Rao AN, Mohan A. Listening to his inner voice? An unusual urethral foreign body: A review of literature and few learning points. Asian J Urol 2018;5:131-2.  Back to cited text no. 2
    
3.
van Ophoven A, deKernion JB. Clinical management of foreign bodies of the genitourinary tract. J Urol. 2000;164:274-87.  Back to cited text no. 3
    
4.
Moon SJ, Kim DH, Chung JH, Jo JK, Son YW, Choi HY, et al. Unusual foreign bodies in the urinary bladder and urethra due to autoerotism. Int Neurourol J 2010;14:186-9.  Back to cited text no. 4
    
5.
Mannan A, Anwar S, Qayyum A, Tasneem RA. Foreign bodies in the urinary blad-der and their management: A Pakistani experience. Singapore Med J 2011;52:24-8.  Back to cited text no. 5
    
6.
Eckford SD, Persad RA, Brewster SF, Gingell JC. Intravesical foreign bodies: five-year review. Br J Urol 1992;69:41-5.  Back to cited text no. 6
    
7.
Jain A, Gupta M, Sadasukhi TC, Dangayach KK. Foreign body (kidney beans) in urinary bladder: An unusual case report. Ann Med Surg (Lond) 2018;32:22-5.  Back to cited text no. 7
    
8.
Rieder J, Brusky J, Tran V, Stern K, Aboseif S. Review of intentionally self-inflicted, accidental and iatrogetic foreign objects in the genitourinary tract. Urol Int 2010;84:471-5.  Back to cited text no. 8
    
9.
Gonzalgo ML, Chan DY. Endoscopic basket extraction of a urethral foreign body. Urology 2003;62:352.  Back to cited text no. 9
    
10.
Kenney RD. Adolescent males who insert genitourinary foreign bodies: Is psychiatric referral required? Urology 1988;32:127-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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