VARIOUS FOREIGN BODIES IN LOWER URINARY TRACT AND MANAGEMENT– A CASE SERIES
SOMANATHA SHARMA.S, JVS PRAKASH, VETRICHANDAR.S, ARASI KV, ARUN KUMAR PARANJOTHI, NATARAJAN.V
DEPARTMENT OF UROLOGY AND RENAL TRANSPLANTATION, GOVERNMENT STANLEY MEDICAL COLLEGE, CHENNAI, INDIA
INTRODUCTION
Foreign bodies in the lower urinary
tract are relatively rare. These range
from tiny to large sizes, may be self-
inserted through the urethra,
iatrogenic, migratory or due to
penetrating trauma.
It is inserted for the purpose of sexual
gratification. It may be also associated
with psychiatric disorders or senility.
Patient with lower tract FBs may be
asymptomatic or have complaints of
dysuria, haematuria, suprapubic pain,
frequency, poor stream and urinary
retention.
Some complications may be
associated with long standing bladder
FBs as recurrent urinary tract infection
and stone formation.
Rarely some patients may develop
serious complications such as
perforation of the urinary bladder or
hydronephrosis with impairment of
renal function.
Various unusual large FBs reported so
far include fish hooks, metal rods,
animal feather, a thermometer, wires,
wooden sticks, pencil, telephone
cables, a gauze pack, a toothbrush,
TURP loop.
Here we report
CASE 2 – METAL WIRE AND
CASE 1 – A PANDORA’S BOX
MASTURBATION
40 year old gentleman used metallic wire
A 34 year-old gentleman presented to our
for sexual gratification during
OPD with c/o severe dysuria and
masturbation and the wire went inside
suprapubic pain following self insertion of
urethra. Presented with dysuria and mild
a ball point pen into the urethra during
haematuria. On examination vitals were
masturbation. On examination vitals were
essentially normal. Xray KUBU revealed
essentially stable, abdomen was soft with
metallic wire in the anterior urethra.
good bowel sounds.
Under local anaesthesia, cystoscopy was
Procedure: Under spinal anaesthesia,
performed and the FB was gently
cystoscopy was performed and pen was
removed with cold cup forceps. Post op
visualized. Using 22 F Nephroscope was
Xray KUBU showed normal anatomy
introduced per urethrally and the pen was
without any residual ROS. Patient voiding
successfully extracted using bi-prongs
well via naturalis.
without any injury to urethra. The
operative time was 45 mins without any
intraoperative complications. 18 F Foley’s
catheter was left in situ for 14 days for
adequate healing of urethra and bladder.
Postoperative period was uneventful. CASE 3 – EDUCATE THE
UNEDUCATED
50 year old gentleman underwent
emergency SPC in 2018 for AUR, had lost
follow up and landed in our emergency
with C/o urinary retention 2 years later.
On exploration, retained SPC with
secondary stones formed in urinary
bladder were removed and closed in 2
layers. Internal urethrotomy was done for
bulbar urethral stricture and urethral
catheterisation was done with 16 Fr
Foley. Post-op period was uneventful.
Patient voiding well till date.
CASE 5 – IATROGENIC FB IN
CASE 4 – A PROLENE NOOSE
BLADDER FOR 10 YEARS
40 years male, a daily wage worker 45 year old lady who had completed family
undergone Copper T insertion 10 years back
admitted with h/o urgency, frequency and
and forgotten to remove it. She presented to
dysuria for 6 years . He had undergone
our OPD with c/o increased frequency and
emergency laparotomy 15 years ago for
occasional haematuria. General examination
Intestinal obstruction and open
was normal. CT KUB revealed copper T inside
cholecystectomy one year ago. Physical
bladder. Cystoscopy was done under
examination was unremarkable.
anaesthesia, Copper T was intact with
Ultrasonography showed an echogenic,
transverse limbs embedded in the bladder
fixed intraluminal lesion in the bladder.
Upper tract was normal. Cystoscopic mucosa and vertical limb encrusted with
secondary calculus. With lithotripter stone
evaluation was performed under
was broken and with the help of grasper Cu T
anesthesia and confirmed presence of 2
device was extracted in toto with minimal
cm calculus formed around prolene knot
damage to bladder mucosa. Bladder filling
fixed to the bladder wall. These sutures
done and no contrast leak noted on c-arm.
had been strangely included in the
Post operative period was uneventful and
bladder wall during midline laparotomy
patient voids well on follow up.
closure. Since the prolene knot was
attached firmly with the rectus sheath, we
decided to open and cystolithotomy was
done. Prolene suture was detached from
bladder. The bladder calculus was
removed and analysis revealed calcium
oxalate as composition. The suprapubic
catheter and urethral Foley were removed REFERENCES
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