An unusual foreign body in the bladder.
GK Bakshi, S Agarwal, SV Shetty
Department of General Surgery, Seth G. S. Medical College and Dr. R. N. Cooper Hospital, Mumbai, India., India
G K Bakshi
Department of General Surgery, Seth G. S. Medical College and Dr. R. N. Cooper Hospital, Mumbai, India.
In spite of its inaccessibility, every conceivable object has been inserted into the urinary bladder. Such patients may have a psychiatric disorder with a sexual perversion or inquisitiveness (as in children) as the underlying cause. We report a case of an aluminum rod inserted into the urinary bladder by an adult male, which was removed successfully by surgery.
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Bakshi G K, Agarwal S, Shetty S V. An unusual foreign body in the bladder. J Postgrad Med 2000;46:41-2
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Bakshi G K, Agarwal S, Shetty S V. An unusual foreign body in the bladder. J Postgrad Med [serial online] 2000 [cited 2019 Oct 16 ];46:41-2
Available from: http://www.jpgmonline.com/text.asp?2000/46/1/41/316
The urinary bladder seems to be an inaccessible site for the introduction of foreign bodies, particularly in the male. However, a review of the literature shows that almost every conceivable object has been inserted into the bladder and each one presents a fresh challenge in both diagnosis and management to the urologist.
A 38-year-old man presented with dysuria and frequency to the outpatients department. A plain abdominal X-ray [Figure:1] was advised that showed a linear radio-opaque shadow lying transversely in the pelvis. On persistent questioning, he gave a history of introduction of a 5.5 cm long aluminium rod [Figure:2] through the urethra into the bladder. Cystoscopy confirmed that an encrusted rod lay within the bladder. An unsuccessful attempt was made to remove the rod cystoscopically. It was then removed via an open cystotomy under spinal anaesthesia. The postoperative period was uneventful. A psychiatric referral was given on discharge.
Introduction of foreign body into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Such objects are inserted usually for eroticism, inquisitiveness (particularly in children), as a consequence of psychiatric or senile states or under the influence of alcohol. There is a marked preponderance of male patients and is probably due to their use of foreign bodies as a masturbatory aid.
Difficulty in the diagnosis lies in patients who choose to ignore the insertion of the foreign body through embarrassment. Previous bladder procedures or surgery to adjacent organs may be relevant when considering the possibility of the presence of a long-standing foreign body. A plain abdominal X-ray followed by cystoscopy usually suffices for the diagnosis.
Management is aimed at providing complete extraction that should be tailored according to the nature of the foreign body with minimal trauma to the bladder and urethra. Most foreign bodies can be removed transurethrally with cystoscopic grasping forceps, but ingenious modifications of conventional instruments have been described to tackle difficult foreign bodies. Open removal via suprapubic cystotomy is sometimes required. After removal, psychiatric referral should be done to prevent repeat presentations with its complications like bladder perforation, abscess and fistula formation. Chronic irritation leading to squamous cell carcinoma of the bladder has also been described.
Eckford SD, Persad RA, Brewster SF, et al. Intravesical foreign bodies; five year review. Br J Urol 1992; 69:41-45.|
|2||Walmsley BH. Removal of foreign bodies from the female bladder. Br J Urol 1987; 59:196. |
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