Foreign bodies inside urinary tract are a relatively rare condition in our practice. There are several reports published and in most cases the reason for self insertion of an object was autoerotic stimulation or psychiatric illness. Self treatment by homemade instruments is a rarely seen scenario. A 62-year-old man presented to our department complaining of lower urinary tract symptoms. On examination, a foreign body was detected inside the urinary bladder. Urethral stricture was also detected for which the patient had been previously treated on several occasions. The patient stated that he had attempted self catheterization using a homemade catheter. He had succeeded in emptying his bladder; however, the catheter entered the bladder completely and was irretrievable to him. Sachse urethrotomy was performed following retrieval of the foreign body. No psychiatric illness was detected in our patient. The patient’s postoperative course was uneventful.Strana tijela unutar mokraćnog sustava su relativno rijetko stanje u našoj praksi. U većini objavljenih slučajeva razlog umetanja stranog tijela je autoerotska stimulacija ili psihijatrijska bolest. Umetanje stranog tijela kao povod za rješavanje mokraćne opstrukcije je rijedak događaj. Bolesnik u dobi od 62 godine javio se na našu kliniku zbog simptoma donjeg mokraćnog trakta. Tijekom pregleda otkriveno je strano tijelo unutar mokraćnog mjehura. Kod bolesnika je u više navrata rađena unutarnja uretrotomija, a jednom otvorena operacija uretre s terminoterminalnom anastomozom. Bolesnik je naveo da je pokušao samokateterizaciju s improviziranim kateterom. Uspio je riješiti mokraćnu opstrukciju, no dio stranog tijela je zaostao u mokraćnom mjehuru. Nakon dodatne obrade učinjena je unutarnja uretrotomija po Sachseu s ekstrakcijom stranog tijela iz mokraćnog mjehura. Psihijatrijskih bolesti se kod bolesnika ne nalazi

Borislav Spajić

Goran Štimac

Igor Grubišić

Ivan Pezelj

Ivan Svaguša

Josip Katušić

English

Hrčak - Portal of scientific journals of Croatia

Acta Clin Croat,  Vol. 53,   No. 3,  2014 359Acta Clin Croat 2014; 53:359-361 Case Report INTRAVESICAL FOREIGN BODY AS A RESULT OF SELF CATHETERIZATION: CASE REPORTIgor Grubišić, Goran Štimac, Ivan Pezelj, Ivan Svaguša, Josip Katušić and Borislav SpajićClinical Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, CroatiaSUMMARY – Foreign bodies inside urinary tract are a relatively rare condition in our practice. There are several reports published and in most cases the reason for self insertion of an object was au-toerotic stimulation or psychiatric illness. Self treatment by homemade instruments is a rarely seen scenario. A 62-year-old man presented to our department complaining of lower urinary tract symp-toms. On examination, a foreign body was detected inside the urinary bladder. Urethral stricture was also detected for which the patient had been previously treated on several occasions. The patient stated that he had attempted self catheterization using a homemade catheter. He had succeeded in emptying his bladder; however, the catheter entered the bladder completely and was irretrievable to him. Sachse urethrotomy was  performed following retrieval of the foreign body. No psychiatric illness was detected in our patient. The patient’s postoperative course was uneventful.Key words: Urinary bladder; Foreign bodies – complications; Foreign bodies – therapy; Intermittent urethral catheterization; Urethrotomy; Case reportsCorrespondence to: Igor Grubišić, MD, Clinical Department of Urology, Sestre milosrdnice University Hospital Center, Vino-gradska c. 29, HR-10000, Zagreb, CroatiaE-mail: igor.grubisic2@zg.t-com.hrReceived November 26, 2013, accepted January 21, 2014IntroductionForeign bodies inside urinary tract are a relatively rare condition. Introduction into the bladder may be through self-insertion, iatrogenic means, or migration from adjacent organs1. The motives for self-insertion are most commonly autoerotic stimulation, psychiat-ric illness and drug abuse and, in this case, attempts of self catheterization. In this group of patients, items such as electric wire, safety pin, hairclip, battery, leech, hairballs, and even fish have been discovered2. In cases of iatrogenic insertion, surgical gauze, pieces of Foley catheter, teflon beak of resectoscope sheath, and intrauterine contraceptive devices were found2. The leading symptoms are usually pain, urinary fre-quency, dysuria, hematuria, and urinary retention3. There are several methods of extraction. In most cas-es, endoscopic method is used4; however, there are re-ports where percutaneous and even open surgery was needed to successfully extract the object.Case ReportA 62-year-old man presented to our department complaining of dysuria, thin urinary stream and he-maturia. He had been treated several times for ure-thral stricture. Recurrent strictures were the result of a polytrauma that included pelvic fractures and trau-ma to the urethra followed by open urethra surgery. Since then, multiple urethrotomy using Sachse knife had been performed, most recently three years before his present symptoms began. Standard examination was performed, which included ultrasound examina-tion of the bladder, where a long coiled foreign body was visualized (Fig. 1). The patient stated that he had used a piece of silicone insulated rope from which he had removed the fiber interior, thus ending up with a silicone tube 5 mm in diameter to self catheterize himself in an attempt to relieve his aforementioned 360 Acta Clin Croat,  Vol. 53,   No. 3,  2014I. Grubišić et al. Intravesical foreign bodysymptoms. His behavior gave no indication of psychi-atric illness, drug abuse or erotic stimulation intent. The self-made catheter slid up the urethra and coiled itself in the bladder. Complete examination was per-formed, followed by intravenous pyelography and mycturition cystourethrography (Fig. 2). There was no evidence for intravesical calculus. No significant pathologic results were found except for the foreign body and urethral stricture of 2 cm in length. A per-manent catheter was placed to allow urine flow until the procedure. Urethroscopy was done with a 22.5 cm cystoscopic sheath and 12 degree scope. The patient had a stricture in the bulbomembranous part of the urethra. Internal urethrotomy using Sachse knife was then performed, followed by cystoscopy. The stricture itself was of rigid consistency resembling cartilage. A piece of silicone insulation approximately 30 cm long was located inside the urinary bladder (Fig. 3). No in-juries or mucosa defects were observed. The tube was extracted using a calculus forceps and a Ch. 18 Fo-ley catheter was placed. Prophylactic antibiotics were administered. There were no postoperative complica-tions. The patient was discharged from the hospital three days after the procedure. When the catheter was removed, on follow up two weeks after the procedure, the patient could urinate without difficulties.DiscussionIntravesical foreign bodies are a rare condition in our practice. Although usually self-introduced with a motive of sexual gratification, in this case the reason was self-treatment. The patient’s behavior gave no in-dication of possibly undiagnosed psychiatric condition or that autoerotic stimulation was intended. There are numerous reports, dating back to the 19th century, of most unusual foreign bodies imaginable including light bulbs, different tools and even fish. With the object, microorganisms are introduced into the blad-der, so recurrent infections are common. The shape and consistency of the object are important for both explaining the symptoms and choosing the method of extraction. For example, if the object is sharp, it will cause injuries to the lower urinary tract, so hematuria will be the leading symptom and can be massive with systemic consequences such as anemia or hypovolemic shock. Extracting such a body without considering the possible complications can cause severe intraop-erative injuries. Sometimes the object is too large to extract with minimally invasive techniques. In those Fig. 1. Ultrasonographic image of the urinary bladder showing the foreign body.Fig. 2. Cystogram phase of intravenous pyelography show-ing a long coiled tube without urethral extension.Fig. 3. The extracted silicone tube was approximately 30 cm in length.Acta Clin Croat,  Vol. 53,   No. 3,  2014 361I. Grubišić et al. Intravesical foreign bodycases, fragmentation is attempted (via laser or using endoscopic instruments) to retrieve the object piece by piece, but sometimes open surgery is required5. In some cases, cystoscopy and cystotomy were used in combination to remove the objects too large to retrieve through the urethra and too solid to fragment them6. Our patient is specific as he attempted to copy the catheterization procedure he had seen performed on him multiple times. Although self-treatment related complications are common in everyday practice, we found no case report on attempting self catheteriza-tion with a homemade catheter without proper train-ing.Introduction of foreign bodies into the bladder may be through self-insertion, as a result of medical procedures, migration from adjacent organs and trau-ma. Extraction methods should be tailored accord-ing to the nature of the foreign body and the specific anatomy to minimize bladder and urethral trauma. An intravesical foreign body should be considered as a possible diagnosis in any patient with chronic unex-plained lower urinary tract symptoms.References1. Eckford Sd, PErSad ra, BrEwStEr Sf, GinGEll JC. Intravesical foreign bodies: five-year review. Br J Urol 1992;69(1):41-5.2. datta B, GhoSh M, BiSwaS S. Foreign bodies in urinary bladders. Saudi J Kidney Dis Transpl 2011;22:302-5.3. Pal dk, BaG AK. Intravesical wire as foreign body in uri-nary bladder. Int Braz J Urol 2005;31:472-4.4. RAFIqUe M. Intravesical foreign bodies: review and current management strategies. Urol J 2008;5:223-31.5. haBErMachEr G, nadlEr rB. intravesical holmium laser fragmentation and removal of detached resectoscope sheath tip. J Urol 2005;174:1296-7.6. delair SM, BErnal rM, kEEGan ka, ElliSon lM. Ship in a bottle: rapid extraction of large intravesical foreign bodies. Urology 2006;67:612-3.SažetakSTRANO TIJELO U MOKRAĆNOM MJEHURU KAO ISHOD SAMOKATETERIZACIJE: PRIKAZ SLUČAJAI. Grubišić, G. Štimac, I. Pezelj, I. Svaguša, J. Katušić i B. SpajićStrana tijela unutar mokraćnog sustava su relativno rijetko stanje u našoj praksi. U većini objavljenih slučajeva razlog umetanja stranog tijela je autoerotska stimulacija ili psihijatrijska bolest. Umetanje stranog tijela kao povod za rješavanje mokraćne opstrukcije je rijedak događaj. Bolesnik u dobi od 62 godine javio se na našu kliniku zbog simptoma donjeg mokraćnog trakta. Tijekom pregleda otkriveno je strano tijelo unutar mokraćnog mjehura. Kod bolesnika je u više navrata rađena unutarnja uretrotomija, a jednom otvorena operacija uretre s terminoterminalnom anastomozom. Bolesnik je naveo da je pokušao samokateterizaciju s improviziranim kateterom. Uspio je riješiti mokraćnu opstrukciju, no dio stranog tijela je zaostao u mokraćnom mjehuru. Nakon dodatne obrade učinjena je unutarnja uretrotomija po Sachseu s ekstrakcijom stranog tijela iz mokraćnog mjehura. Psihijatrijskih bolesti se kod bolesnika ne nalazi.Ključne riječi: Mokraćni mjehur; Strana tijela – komplikacije; Strana tijela – terapija; Intermitentna uretralna kateterizacija; Uretrotomija; Prikazi slučaja

Strano tijelo u mokraćnom mjehuru kao ishod samokateterizacije: prikaz slučaja

HRČAK - Portal of Croatian Scientific and Professional Journals

Strano tijelo u mokraćnom mjehuru kao ishod samokateterizacije: prikaz slučaja

Abstract

Similar works

Full text

Available Versions

Hrčak - Portal of scientific journals of Croatia

HRČAK - Portal of Croatian Scientific and Professional Journals