WIRE AS FOREIGN BODY IN URINARY BLADDER
DILIP K. PAL, ASIM K. BAG
Departments of Urology and Radiology, Medical College and Hospital, Kolkata, India
Foreign bodies in the urinary bladder are frequently the objects of jokes among doctors, but they may sometimes cause serious implications to the patients. Here we present our experiences in 3 such cases where long segments of wire were introduced into the urinary bladder through the urethra.
words: urinary bladder; foreign bodies; calculus
A multitude of foreign bodies have been found in the urinary bladder, such as a needle, a bullet, a safety pin, an animal feather, pieces of candle, a thermometer, chewing gum, a Steinman pin, a gauze pack, a toothbrush, a metal hook, and a scalpel blade etc., as reported in the literature (1-3). In most cases, they are either self introduced to produce erotic sensations and sexual gratification or introduced by someone else to get relief from urinary complaints (2). Here we report 3 cases and their successful management.
1 - An 18-year-old boy presented with complaints of dysuria, terminal
hematuria and suprapubic pain that had lasted for 2 weeks. A hysical examination
was unremarkable. Urinalysis showed plenty of pus cells with significant
growth of E. coli in the urine culture. An X-ray of the pelvis showed
a coiled up radiopaque shadow in the bladder region (Figure-1). Upon further
interrogation, the patient admitted that he was used to masturbating by
introducing an electric wire through the urethra. One month previous,
he had lost the wire inside his erected penis during this process. Under
general anesthesia, a 16-inch long electric wire was removed through cystoscope
with an uneventful recovery.
Foreign bodies may find their way into the urinary bladder by accident, deliberate introduction through the urethra or migration from the neighboring organs (1-3). When a wire is introduced through the urethra, part of it remains in the urethra and part goes to the bladder cavity. At the time of micturation, the contracting bladder curled the part of the wire that had partly moved into the bladder from the urethra. Gradually the whole of the wire originally present in the urethra was pulled into the bladder (2). To avoid embarrassment, patients tend to seek treatment late, often waiting until the problem becomes symptomatic (3). Usually the patients present with urethritis, cystitis, recurrent UTI, or hematuria (1-3). X-rays are sufficient to diagnose such conditions. Intravenous urography rarely gives any additional information, and is indicated only to diagnose radiolucent objects. Cystoscopy gives the final diagnosis in doubtful cases. Managing the situation seeks to remove the foreign body with minimum trauma, and cystoscopic removal is the ideal approach. Where a stone has formed, it should be broken by litholapaxy or intracorporeal lithotripsy together with the removal of the foreign body. Large foreign bodies may be removed by suprapubic cystostomy where endoscopic removal is not possible.