Research Article
Retrospective Analysis of Foreign Bodies in the Lower Urinary Tract: A 5 Years-Single Center Experience
Mustafa Ozan Horsanali1*, Kutan Ozer1, Utku Eser, Omer Faruk Altaş2 and Ahmet Selçuk Dindar3
1Department of Urology, University Ataturk Training and Research Hospital, Turkey
2Department of Family Medicine, University Ataturk Training and Research Hospital, Turkey
3Department of Anesthesiology and Reanimation, University Ataturk Training and Research Hospital, Turkey
*Corresponding author: Mustafa Ozan HORSANALI, Izmir Katip Celebi University Ataturk Training and Research Hospital, Urology Department Izmir, Turkey
Published: 17 Nov, 2016
Cite this article as: Horsanali MO, Ozer K, Eser U, Altaş
OF, Dindar AS. Retrospective Analysis
of Foreign Bodies in the Lower
Urinary Tract: A 5 Years-Single Center
Experience. Ann Clin Case Rep. 2016;
1: 1182.
Abstract
Introduction: Foreign bodies in the urinary tract are among the most common urologic problems due to different etiologies. In this present study, we aimed to review our experience about lower
urinary tract foreign bodies.
Methods: We analysed 22 patients that underwent surgical treatment for foreign bodies in lower
urinary tract. All the patients underwent cystoscopy under general anesthesia for direct visualization
of the foreign body within the lower urinary tract and cystoscopic removal of the foreign body is
attempted. If cystoscopic removal failed, then open cystostomy was performed to remove it.
Results: Mean age of patients were 53, 5 ± 19,1 years old. 17 (77%) patients treated with
endoscopically, besides 5(23%) patient treated with open surgery. We revealed that 10 (45,5%)
patients have erectile dysfunction and 12 (55,5%) patients have no sexual disorders.
Conclusions: Cystoscopic removal is usually successful for removing most of the foreign bodies
from the bladder; but when it fails, then suprapubic cystostomy can be the alternative procedure.
Keywords: Foreign Body; Bladder; Urethra; Endoscopy
Introduction
Foreign bodies (FBs) in the urinary tract are among the most common urologic problems due
to different etiologies. Although they are usually iatrogenic in the upper urinary tract, FBs in the
bladder and/or urethra may be due to iatrogenic, self-insertion, and rarely migration from adjacent
organs [1]. Bladder/urethral FBs can be observed in various circumstances such as exotic impulse, mental illness, borderline personality disorders, sexual curiosity, or sexual practice in addition to
iatrogenic causes. During sexual activity or self-stimulation, FBs can be pushed forward into bladder
via the urethra [2]. Different types of foreign bodies have been removed from the urinary bladder, which include electric wire, safety pin, hairclip, intrauterine contraceptive device (IUCD), gauze
pieces, battery, leech, hairballs and so on [3-6].
In our present study, we aimed to review our experience about lower urinary tract FBs. We also
looked at the etiology of FBs, methods of treatment and management in different localizations.
Material and Methods
In this retrospective study, we analysed 22 patients that underwent surgical treatment for FBs in lower urinary tract between 2010 and 2015 in our clinic. All the patients’ data were collected from
our hospital’s patient database. Patients’ age, gender, concurrent disease, sexual habits, treatment
methods and type of FBs were recorded. Medical history and past operations were recorded. All the
patients were referred for psychiatric consultation to evaluate psychiatric disorders. Pre-operative
antibiotic prophylaxis (first-generation cephalosporin) was given in all cases. All the patients
underwent cystoscopy under general anesthesia for direct visualization of the FBs within the lower
urinary tract and cystoscopic removal of the foreign body is attempted. If cystoscopic removal
failed, then open cystostomy was performed to remove it.
All the categorical variables were analyzed with descriptive methods. For all statistical analyses,
SPSS 22.0 package program was used.
Results and Discussion
Mean age of patients were 53,5 ± 19,1 years old. 15 (68,2%)
of the patients were male and 7(31,8%) of were female. 17(77%)
patients were treated with endoscopically, besides 5 (23%) patients
were treated with open surgery. FBs were localized in the bladder
in 16 (72,7%) patients and it were localized into the urethra in 6
(27,3%) patients. Type of FBs that were extracted from the lower
urinary tract is summarized in table 1 and etiologic causes of FBs
are summarized in table 2. In sexual examination we revealed that
10(45,5%) patients have erectile dysfunction and 12 (55,5%) patients
have no sexual disorders. During the surgery, we detected bladder
cancer in 1 patient and external meatus stricture in other 1 patient,
concurrently.
Foreign bodies in the urinary tract are among the most common
urologic problems due to different etiologies and can occur either by
self introduction or by migration from adjacent organs [6]. In our
present study, migration of FBs from adjacent organs were seen in 6
patients and 16 patients have done self introduction.
Introduction of the foreign bodies can be voluntary and related
to a psychiatric disorder or can occur by accidental penetration of
objects or iatrogenic trauma due to firearms. X-rays show a radioopaque
foreign body, but they may be unremarkable when the foreign
body is radio-transparent. In this situation, an ultrasonogram can
objectify bright echogenic foci with distal acoustic shadowing [7].
In addition, cystoscopy is essential to confirm the diagnosis and in
the attempt for its removal. In most of the cases, foreign bodies can
be removed from the bladder through the cystoscope. Recently, Ho:
YAG laser has been used to fragment the large size foreign body
inside the bladder and facilitate its removal through the cystoscope
with a forceps [8].
Psychiatric disorders have been reported in patients admitted for
self introduction of foreign bodies into the bladder as an act of sexual
satisfaction [9]. Psychiatric evaluation of all such patients has been
recommended [3]. Psychiatric evaluation was done in such patients in
our study, only 2 patients were diagnosed with psychiatric disorders
such as mental retardation by the consultant psychiatrist, but 10
patients without any psychiatric disorder, made self introduction
during sexual activity. And also, we detected erectile dysfunction in
these patients who insert foreign bodies into their urethra themselves
to provide rigid erection during the sexual activity. We consider that
erectile dysfunction is major causes that underlying self insertion of
foreign bodies into lower urinary tract. If patient have no psychiatric disorder and have erectile dysfunction, this problem must be treated after surgery.
The therapeutic approach depends on the patient’s condition,
the assessment of the lesions, and the size, shape and nature of the
intravesical foreign body. ssThe extraction of a foreign body in the
bladder can be performed through surgical exploration [10]. We
performed endoscopic surgery in 17 patients and open surgery in 5
patients.
Migration of intra uterine device (IUD) is not uncommon; it
may penetrate into retrovesical space in the peritoneum, bowel and
bladder [11-13]. The most frequent sites of migration are, omentum
(26.7%), douglas pouch (21.5%), large bowel (10.4%), myometrium
(7.4%), broad ligament (6.7%), free within in the abdomen (5.2%),
adhesion to ileal loop serosa (4.4%) or to large bowel serosa (3.7%)
and mesentery (3%). Rare sites are represented by appendix,
abdominal wall, ovary and bladder [14]. In this study we showed that
only 2 patients IUD migrated to bladder and one of them was covered
with stone.
Catheters and endoscopic instruments are the most common
iatrogenic objects introduced into the bladder by urologists. Catheter
tips, parts of catheter balloons, buggies, and beaks of resectoscope
sheathes are some things that have been recovered from bladders [15-
17]. We removed parts of catheter ballons in 5 patients with FBs in
bladder.
Table 1
Table 2
Conclusion
Foreign bodies in the bladder are not uncommon situation. It can occur by self introduction into urinary tract or migration from adjacent organs. Cystoscopic removal is usually successful for removing most of the foreign bodies from the bladder; but when it fails, then suprapubic cystostomy can be the alternative procedure. Erectile dysfunction may be the major causes of self insertion of FBs into the lower urinary tract.
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