Urethral Foreign Body Research Articles

A Case of Urethral Foreign Body from 40 Years Ago with Scrotum Abscess and Urethroscrotal Fistula

A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.

The endoscopic removal of urethral foreign body (a fragment of an artillery shell): a clinical case

Gunshot wounds of the external genitalia are present in two-thirds of all penetrating genitourinary trauma in the military setting with prevailing shrapnel wounds.The reported clinical case is aimed at providing rational and demonstrating benefits of endoscopic removal of a splinter from the urethral lumen.The clinical case presents the successful removal of a splinter from the urethral lumen. A 22-year-old man suffered gunshot shrapnel wound to the scrotum and urethra 7 months ago, а splinter was located in the urethral lumen and was successfully removed using endoscopic approach. In some cases X-ray diagnosis does not allow detecting the exact location of the splinter. Therefore, it is rational to use endourological diagnostic procedures.

A Sewing Needle as a Urethral Foreign Body: A Case Report and Literature Review

ABSTRACT Foreign bodies in the urethra can occur by self-insertion, and patients often hide the symptoms due to embarrassment. Foreign bodies act as a focus for infection and abscess formation and result in perforation or fistula when not detected on time. Foreign bodies can display symptoms such as frequent urination, dysuria, hematuria, urethrorrhagia, and obstruction. This case discusses a self-inserted urethral sewing needle that was removed cystoscopically from an adolescent.

Man with urethral foreign body sensation.

Man with urethral foreign body sensation.

Management of iatrogenic urethral foreign body after mid-urethral sling A literature review.

Urethral mesh perforation is a rare complication of mid-urethral sling resulting in a lack of clear management guidelines. Thus, we aimed to determine management options and their respective outcomes in terms of erosion resolution and continence. A literature review was performed by extracting studies from the PubMed, Cochrane, and Google Scholar from January 1996 to December 1, 2022. Only French and English language studies were included. A total of 227 papers were screened and assessed for eligibility. Forty-eight studies were included in the final analysis, for a total of 224 patients. Treatment options consisted of conservative, endoscopic, transurethral, and transvaginal approaches. Conservative treatment was associated with a 100% risk of persistence or recurrence of urethral perforation, while the failure rates for endoscopic, transurethral, and transvaginal approaches were 33%, 7.5%, and 7%, respectively. Most patients suffered from stress urinary incontinence after reconstructive management. The most common symptoms at the time of presentation were overactive bladder and pain. The mean time between the onset of symptoms and diagnosis was 10 months. About half of the urethral mesh perforations were diagnosed within the first years after the initial sling insertion. Multiple management options for sling penetration of the urethra have been described in the literature. Transvaginal sling resection with consecutive tissue interposition seems to carry the lowest risk of erosion recurrence; however, all treatment options are associated with a high relapse rate for stress urinary incontinence.

Wandering projectile, a rare cause of acute urinary retention

BackgroundUrethral obstruction due to retained projectile migrating into the genitourinary system has rarely been reported. The literature describes two main methods of retained projectile removal from the genitourinary system: (1) spontaneous expulsion during voiding and (2) manual extraction due to urethral obstruction causing acute urinary retention.Clinical presentationWe present a case in which a 23-year-old man presented with acute urinary retention four days after suffering a gunshot wound to the right distal posterolateral thigh. A retained projectile eroded through the posterior wall (slightly to the right) of the bulbar urethra at the bulb, migrated through the urethra, and eventually became lodged in the external urethral meatus, causing obstruction and acute urinary retention. Subsequently, the foreign body was removed with manual extraction along with gentle external pressure under sedation and the patient was discharged with a 16 Fr transurethral catheter in situ to be kept for 1 week and removed after a week.ConclusionThe absences of signs do not always effectively rule out urethral or bladder injury. Urethral foreign bodies are not commonly encountered when they do the entry is usually the urethral meatus. However, the treating physician must that other mechanisms also exist especially in those with bullet injury to flank, abdomen, pelvis and even the distal thigh like our case.

Clinical Features and Management of Urethral Foreign Bodies in Children: A 10-Year Retrospective Study

(1) Background: Urethral foreign bodies (UFBs) are very rare in children, and their treatment remains challenging. (2) Methods: A retrospective analysis was performed on 40 patients who were admitted to our hospital due to UFBs from June 2011 to June 2021. The clinical features and treatment experiences of these children are summarized. (3) Results: A total of 40 children were enrolled in the study, 17 boys and 23 girls. A majority of the boys (median age: 11.8 years) were of puberal age, and the main cause of the UFBs was sexual gratification (94.1%). Girls were almost always in early childhood (median age: 1.8 years), and most of the UFBs were related to specific clothing in specific regions and seasons. Ultrasound had a high accuracy in the diagnosis of female UFBs; the sensitivity and specificity were 88.9% and 85.7%, respectively. Most UFBs could be removed using a cystoscope (82.4% in boys, 100% in girls). All the children had a good prognosis and no complications occurred during follow-up. (4) Conclusions: Ultrasound is a reliable and sensitive method for the diagnosis of UFBs in girls. Cystoscopy is a reliable surgical method for UFBs.

P16 Endoloop ligatures in the retrieval of urethral foreign bodies: a narrative review

Abstract Introduction Self-insertion of foreign bodies into the urethra has been described previously in patients presenting to hospital emergency services. Treatment typically involves procedural retrieval under local anaesthesia using basket or forceps, cystoscopy, or open surgery. An Endoloop is a device designed to snare colonic polyps during endoscopy with nylon loops. It is not traditionally used for retrieval of urethral foreign bodies. Our objective was to determine the incidence, safety and efficacy of this approach. Methods A narrative review was performed. Primary outcomes were technical success, defined as uncomplicated retrieval of foreign body, and adverse events related to pain, bleeding, infection, and damage to structures. Electronic searches were performed using PubMed, Embase and Google Scholar. Reference lists of selected studies were searched manually. Results 2 case studies met inclusion criteria for analysis, both describing self-insertion of urethral foreign bodies for purposes of sexual arousal. These comprised a 30-year-old male (magnets) and a 29- year-old female (metal urethral sound). Both patients underwent successful retrieval of foreign body using an Endoloop ligature. There were no symptoms post-operatively and no procedural complications were reported. Conclusion An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval. Follow-up is mandatory to monitor for complications due to foreign body insertion such as urethritis, incontinence, fistula and diverticulum formation. Referral to psychological services is encouraged to reduce the risk of recurrence. Further studies are required to validate the efficacy and safety of this technique. Take-home message An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval of urethral foreign bodies.

Migrated Sewing in Urethra in a Young Male, Tricky Situation Sorted with Cystoscope

The self-insertion of sewing needles into the urethra is an unusual emergency faced by a urologist. The most common cause for self-insertion of urethral foreign bodies is unknown however autoerotism/psychological impairment has been implicated. Because of guilt and embarrassment, patients usually do not take medical advice unless he is symptomatic. A 24-year male inserted a sewing needle through the urethra for autoerotic stimulation which has impacted at proximal bulbar urethra and piercing the post wall of the urethra towards the rectum. The needle was successfully removed by cystoscope assistance with difficulty after grasping with forceps. Follow-up after cystourethroscopy is important for diagnosing urethral stricture. The main objective of this case reports that foreign bodies inserted especially in the urethra can migrate. Milking of a needle is contraindicated as it may pierce the urethra and migrate to adjacent structures. Removal of these needles under cystoscopy guidance is mandatory.

Self-Insertion of Urethral Foreign Body: Performing Azayem Procedure for Metal Forceps Removal from Urethra

Self-inserted male urethral foreign bodies are urological emergencies that we as urologists might have to deal with in the future. The number of case self-inserted foreign bodies have been increasing respectively the last decade especially in male patients. We report a case of a 27-year-old male with a self-inserted foreign body (forceps) into the urethra and the evacuation using the Azayem procedure. The presentation consists of the clinical features of this patient, including medical history, signs, and symptoms, imaging examinations were recorded. After diagnosis and endoscopic preparations, the procedure to evacuate a self-inserted foreign body was performed. We performed the Azayem procedure on the patient who was complaining of dysuria, hematuria, pyuria, and palpable urethral foreign body caused by forceps that was self-inserted 11 days before admission. Azayem procedure is a simple endoscopic technique for removing the metal hair removal forceps from the urethra. We then treated the urethral injury and the infection as the most concerning complications. Psychology follow-up by psychiatrist, urethrography and International Prostate Symptom Score evaluation was taken as the follow-up post-procedure.A self-inserted foreign body is a rare case and life-threatening related to urosepsis caused by the late intervention. The variety of foreign bodies inserted into the urethra includes forceps. Azayem procedure is an effective approach to evacuate forceps as the urethral foreign body because this endoscopic procedure is relatively simple to perform and has a minimal procedural complication.

Self-Inserted Urethral Foreign Body

Self insertion of foreign body in a male urethra is rare. Foreign bodies are mostly inserted by intoxicated, confused, and sexually curious individuals. In addition to a suitable method of surgical removal, counseling and psychiatric evaluation are often necessary to prevent recurrences.

Dual-Energy Computed Tomography for the Diagnosis of Urethral Foreign Body: A Case Study

Foreign body insertion in the urethra and bladder is not uncommon and has been reported in many studies to date. However, since foreign bodies are often accidentally introduced into the urethra and bladder during masturbation, they take a variety of shapes and sizes. Furthermore, patient self-reports are typically unreliable as many patients feel ashamed; thus, appropriate preoperative diagnosis is critical. Diagnosis of foreign body insertion in the urethra and bladder is performed using imaging modalities such as abdominal X-ray and computed tomography (CT). However, single-energy CT (SECT) is not sufficient in detecting foreign bodies in some cases. In the present study, we report a successful preoperative identification of urethral foreign body in a patient using dual-energy CT (DECT).

Needle as foreign body in urethra: Successful removal

: Self-inserted foreign bodies in the lower urinary tract are rare among children. The treatment of foreign bodies in the urethra is determined by their type, size, location, shape, and mobility. : We describe here a 10-year-old boy who had self inserted a needle into his urethra. Initial attempts to remove the needle from the urethra by inserting a cystoscope failed. The patient presented to our institution with bleeding per urethra with feeding tube insitu per urethra. As already attempted for urethroscopic removal, direct removal of needle done under general aneathesia done.: Per Rectal examination plays an important role and gives adequate information and timely management of the child leads to uneventful hospital stay Psychiatric evaluation is mandatory to detect an underlying mental disorder.

Sewing Needle as Foreign Body in Urethra of an Adolescent Boy

Self-insertion of a foreign body in the urethra is an uncommon presentation clinically. The cases usually arise due to fulfillment of sexual desire, for recreation, play, or exploration, or the foreign body insertion may take place accidentally. We present a case of an adolescent boy with a foreign body urethra presenting to the emergency room with urinary retention, pain, and dysuria. Attending urologist suspected urethral stricture and ordered ultrasonography to investigate which turned out to be a sewing needle in his urethra. The patient was then enquired about the foreign body. He tried to self-dilate his urethra as he was experiencing lower urinary tract symptoms. The sewing needle was removed by endoscopy and he was administered with antibiotics and painkillers. The urethral foreign bodies may present with pain, dysuria, or urinary incontinence and these foreign bodies are mostly seen in the male population in the adolescent age group.

Clinical presentation and treatment of Macroplastique® urethral exposures: a retrospective case series.

Manufacturers of Macroplastique® for urethral bulking have not previously reported exposures as potential complications. This study was aimed at identifying presenting symptoms, management, and outcomes in patients experiencing urethral or bladder exposures. A retrospective case series from 2010 to 2019 was performed in an academic affiliated hospital system. Participants were 18-89years old and received Macroplastique® urethral bulking for treatment of stress urinary incontinence. Charts were identified through diagnosis and procedure codes relating to injections of urethral bulking agents and foreign bodies in the bladder or urethra. Factors evaluated were patient history and presenting symptoms, diagnostic evaluation, treatment, and outcomes using frequency tables for categorical values and statistical distribution with median and interquartile ranges (IQR) for continuous variables. After review of 1,269 charts, 580 cases met the inclusion criteria and 14 Macroplastique® urethral exposures were identified. The median age at first presentation was 73.5years (IQR57.5-79.7years) with 48months (IQR 22-78months) as the median time to first presentation after last Macroplastique® injection. The median number of injection sessions was 2 (IQR 1-2.75 sessions) with a medium volume of 4.5ml (IQR 2.75-9.0ml). Presenting symptoms included urge incontinence (64.3%), stress urinary incontinence (57.1%), recurrent urinary tract infection (42.9%), urinary urgency (28.9%), urinary frequency (28.9%), urinary retention (14.3%), and interrupted flow (7.1%). Macroplastique® urethral exposures were extracted in 10 patients using blunt, sharp, or electrocautery excision. No complications after excision were identified and improvement in urinary symptoms was observed. Urethral bulking with Macroplastique® can lead to symptomatic urethral exposures.

PENs in the PENis: a case report and brief review of the literature

BackgroundAccording to the literature, there have been reports of introduction of foreign bodies into the urethra predominantly in males, both adults and children. Erotic stimulation, intoxication, assault and psychiatric conditions are the most frequent contributors.Case presentationA 70-year-old male presented with difficulty in passing urine for one week after having inserted two plastic ballpoint pens into his urethra. The patient had a failed attempt at removal using a rigid cystoscope and biopsy forceps. A Liga-clip applicator allowed successful blind removal of both pens while the patient was under a general anaesthetic.ConclusionsRemoval of urethral foreign bodies can be challenging as endoscopic removal may fail, and open or blind procedures may be required. Moreover, complications can be significant. On occasions, improvisations in techniques may be helpful, such as in our patient. A psychiatric review is vital to try and ensure the prevention of repeat incidents.

Unusual self-inflicted foreign bodies in the urethra

Self-inflicted urethral foreign body insertion in men is very rare and an important condition which urologists encounter in their clinical practice. Urologists should be familiar with the different techniques for the removal of these foreign bodies. Most cases are associated with psychiatric disorders. Hence, they should be referred for complete psychiatric evaluation. The emotional condition of the patient and the circumstances under which this act was committed should be investigated at the same time. Many cases of self-inflicted foreign body in the urethra have been reported in the literature such as fishhooks and bullets. However, metallic tongue cleaner in urethra has not yet been reported. Here, we are reporting the case of a 28-year-old male who presented with dysuria for 1 day following insertion of metallic tongue cleaner in the penile urethra, for sexual gratification which, he was unable to remove. The foreign bodies were found in the anterior urethra on X-ray and were successfully removed endoscopically without any complication. The patient was advised to take psychiatric consultation and counseling to prevent future episodes.

Evaluation and management of urethral foreign bodies and description of a novel ultrasound-guided catheter-based extraction technique.

There are numerous reports in the medical literature documenting urethral foreign bodies with nearly all cases found in men and often associated with underlying psychiatric disorders, autoerotic stimulation, and/or intoxication. Patients most commonly presented with localized penile pain, hematuria, dysuria, and occasionally obstruction. Although endoscopic removal by a urologist is often the first‐line treatment, this report describes evaluation and management considerations and presents a novel extraction technique that may allow emergency physicians in consultation with urology to perform removal of some unusual urethral foreign bodies in the emergency department.We report a novel extraction technique using a pediatric foley catheter under ultrasound guidance that has been applied during multiple encounters with 2 individuals who have each presented multiple times at a single emergency department (ED) for evaluation because of urethral foreign body insertion. The foreign body materials have ranged from small pieces of rubber to cellophane to styrofoam and most commonly plastic utensils. Urologic extraction may be required in some cases, but ED removal can be considered. A final discussion of the creation of a multidisciplinary care plan to address resource use concerns also is described.

Thinking outside the loop: use of an endoloop in retrieving a urethral foreign body

Thinking outside the loop: use of an endoloop in retrieving a urethral foreign body

Case Report: Using Point-of-care Ultrasound as a Tool to Identify a Urethral Foreign Body.

IntroductionWhen patients present to the emergency department with retained urethral foreign objects, imaging is crucial for identifying and further describing the object(s). Imaging is also important to plan the management and to assess the potential complications of foreign object removal. Ultrasonography is sometimes used for this purpose and can often provide more information on the object and its location and characteristics than plain radiographs.Case ReportThis case report discusses the identification and characterization of a retained urethral foreign object that was not seen on plain radiography.ConclusionWhile ultrasonography has its own limitations, in the cases of retained foreign objects, it can provide preferable imaging and can help guide the management of these patients.