Foreign bodies of the urethra and bladder are rare clinical entities and are most commonly associated with self-insertion, iatrogenic causes, or migration from adjacent anatomical structures. Individuals who are intoxicated, mentally confused, or sexually curious are at higher risk. Delayed presentation is frequent due to embarrassment and guilt, which may result in complications. We report the case of a 32-year-old unmarried male who presented with acute difficulty in micturition for one day. Physical examination revealed a palpable elongated foreign body extending from the distal penis to the penoscrotal junction. Pelvic X-ray confirmed the presence of an approximately 9–10 cm foreign body lodged in the anterior urethra. The patient had no associated systemic symptoms. Prompt diagnosis was made based on clinical examination and imaging findings. Management of urethral foreign bodies focuses on safe extraction, early recognition of complications, and preservation of erectile function. Endoscopic removal is preferred for foreign bodies located distal to the urogenital diaphragm, as it minimizes trauma and reduces the risk of long-term complications. Invasive surgical procedures are associated with higher morbidity, including infection, urethral stricture, fistula formation, and urinary incontinence. Early diagnosis and appropriate intervention are essential to ensure favorable outcomes.
Foreign body of the urethra and bladder are infrequently seen in clinical practice. Causes can range from iatrogenic injury, self-insertion to migration from adjacent sites [1]. Intoxicated, confused, sexually curious are more likely to insert foreign bodies in urethra. Treatment is mainly by foreign body extraction, early diagnosis of complications and preservation of erectile function [2].
Case Report
A 32-year-old bachelor male presented to OPD with difficulty in micturition for last 1 day. The patient had no other urological symptoms, fever or chills. On physical examination a non-distended bladder was present. A long foreign body was palpable just beyond tip of penis to penoscrotal junction. X ray of pelvis showed that an approximately 9-10 cm foreign body in anterior urethra (Figure 1).
Figure 1: X-ray Pelvis Showing the Foreign Body
Patient was taken to emergency operating room. Meatotomy was done under regional anesthesia and 9cm foreign body was removed (Figure 2).
Figure 2: Removed Foreign Body
At the end of the procedure wound was closed and urethral catheter was inserted. Patient went home post procedure. The patient was followed up at weekly intervals, urinary catheter was removed on 14th post operative day. The external wound had healed well and there was no difficulty in voiding urine. Patient was advised psychiatric evaluation which was refused by family members.
Self-insertion of patients feel humiliated, guilty and often there is delay in asking for help [4]. This leads to multiple self-removal attempts causing urethral injury and further migration of foreign body. Cases have been reported with psychiatric disorders [5-6], drug intoxication [5-6], mental confusion [7], sexual curiosity or a desire to get relief from urinary symptoms. Lack of partner or spouse and misconception about masturbation was noted as cause in many patients.
Diagnosis is based on physical examination. Foreign body distal to urogenital diaphragm are readily palpable. A pelvic x-ray and CT-scan of abdomen can define the position of foreign body, its orientation and relationship with surrounding structures [2]. With aim to minimize trauma and preserve erectile function, foreign bodies distal to urogenital diaphragm can be extracted by endoscopic methods [4,8]. Invasive procedures like external urethrotomy, supra pubic cystotomy or meatotomy [8-9] are associated with complications like infection, fistula, urethral stricture and incontinence [4,8-9]. Urethral strictures (5%) are most common Complication [8]. Regular follow up is recommended for early diagnosis of complications. In the reported case no complications were seen after meatotomy.
Extraction of urethral foreign body is based upon its morphology and position. A more holistic approach to management of urethral injury is required. This includes prevention of complications or further urethral injury. Psychiatric consultation is recommended to prevent future episodes.
Moon, S.J. et al. “Unusual Foreign Bodies in the Urinary Bladder and Urethra Due to Autoerotism.” International Neurourology Journal, vol. 14, no. 3, October 2010, pp. 186.
Naidu, K. et al. “An Unusual Urethral Foreign Body.” International Journal of Surgery Case Reports, vol. 4, no. 11, January 2013, pp. 1052–1054.
Mahadevappa, N. et al. “Self-Inflicted Foreign Bodies in Lower Genitourinary Tract in Males: Our Experience and Review of Literature.” Urology Annals, vol. 8, no. 3, July 2016, pp. 338.
Bedi, N. et al. “‘Putting Lead in Your Pencil’: Self-Insertion of an Unusual Urethral Foreign Body for Sexual Gratification.” JRSM Short Reports, vol. 1, no. 2, July 2010, pp. 1–5.
Van Ophoven, A. and J.B. De Kernion. “Clinical Management of Foreign Bodies of the Genitourinary Tract.” The Journal of Urology, vol. 164, no. 2, August 2000, pp. 274–287.
Gonzalgo, M.L. and D.Y. Chan. “Endoscopic Basket Extraction of a Urethral Foreign Body.” Urology, vol. 62, no. 2, August 2003, pp. 352.
Trehan, R.K. et al. “Successful Removal of a Telephone Cable, a Foreign Body through the Urethra into the Bladder: A Case Report.” Journal of Medical Case Reports, vol. 1, no. 1, December 2007, pp. 1–3.
Mannan, A. et al. “Foreign Bodies in the Urinary Bladder and Their Management: A Pakistani Experience.” Singapore Medical Journal, vol. 52, no. 1, January 2011, pp. 24.
Poole-Wilson, D.S. “Discussion on Urethral Injuries.” Proceedings of the Royal Society of Medicine: Section of Urology, vol. 49, 1956, pp. 685–910.
Download PDF
Download PDF
Download PDF
Download PDF
Download XML
