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Abdominal X-ray revealed a radiopaque foreign body (white arrow) in left inferior quadrant compatible with a pen tip.
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Numerous accounts documenting the introduction of foreign bodies into the urinary bladder have been reported. These foreign bodies are typically self-inserted via urethral but migration from adjacent organs by an ulcerative process and penetrating injuries are also reported. However, ''contrary'' migration of a self-inflicted vesical foreign body t...
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Citations
... Bladder perforation due to a bladder foreign body is even rarer, but it does exist and may lead to open surgery. [1]. Foreign bodies can be of various types, including pencils, thermometers, glass rods, or toothbrushes. ...
The presence of an intravesical foreign body is a rare condition concerning the diseases of the urinary system. Intravesical foreign bodies may cause hematuria and bladder perforation, which are difficult to diagnose and treat. There are various types of foreign bodies in the bladder; however, magnetic beads are rare. Multiple beads may be inserted into the urethra. A few small magnetic beads may be removed from the urethra, but an open removal is an option for many or large beads because of calculus adherence. This case reports the successful open removal of 57 magnetic beads with calculus adherence.
... Perforation of the bladder is a rare event after urethral sounding and is usually associated with a sharp object or retained foreign body in the bladder for a prolonged duration [12,13]. In the present case, the patient presented soon after the insertion of a blunt marking pen. ...
Urethral sounding is the insertion of an object or liquid into the urethra for sexual gratification. It is associated with a substantial risk of loss of the foreign body in the bladder, urethral strictures or infection. Bladder perforation is a rare complication of urethral sounding which is usually associated with a sharp object. Here, we present the case of a young adult female presenting with abdominal pain after practicing urethral sounding with a blunt marking pen. She was found to have an intraperitoneal bladder perforation, requiring exploratory laparotomy and bladder repair.
... More complex procedures, such as laparotomy and urinary diversion, may be required in complicated cases. The surgical approach should be individualized [9]. Psychiatric consultation of all patients is needed [7]. ...
... Some of the unusual self-in icted long bladder foreign bodies reported in journals are metal rods, wooden sticks, and telephone cables. 3 case reports of a pen in the urinary bladder have been reported all in female patients 4,5,6 . A pencil, a clinical thermometer, a toothbrush, and a fetal bone in the urinary bladder have also been reported in women. ...
Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra.
Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction.
Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available
... Some of the unusual self-in icted long bladder foreign bodies reported in journals are metal rods, wooden sticks and telephone cables. 3 case reports of pen in the urinary bladder have been reported all in female patients 4,5,6 . A pencil, a clinical thermometer, a toothbrush and a fetal bone in urinary bladder have also been reported in women. ...
Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra.
Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction.
Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available
... 8,13,14,18 Cury et al. have reported an interesting but rare complication of retroperitoneal migration of a self-inserted ball point pen via the urethra. 21 Psychoanalytical theories have been postulated to account for the self-infliction of objects for sexual gratification. Kenny's theory states that "the initiating event is an accidentally discovered pleasurable stimulation of the urethra which is followed by repetition of this action using objects of unknown danger driven by a particular psychological predisposition to sexual gratification". ...
... 2,7 Occasionally it is also necessary to have a computerized tomography scan (CT) and magnetic resonance imaging. 21 The definitive treatment of intra-vesical FB involves their removal by either cystoscopy or open surgery. 2 The goal of management should be to provide complete removal of the FB. This should be guided by the nature of the FB and must ensure minimal trauma to the bladder and urethra. ...
... There are however, few reports on foreign bodies in the genitourinary tract emanating from sub-Saharan Africa when compared to the rest of the world.9,18,19,20 A review of the literature on this subject revealed that a wide variety of substances has been found in the urethra and urinary bladder of patients.1,2,3,7,11,14,17,21,22,23,24,25 More cases of urethral and intra-vesical FBs are seen in men than in women with a ratio of 1.7:1. ...
DISCLOSURE The authors declare no conflict of interest or any financial support ABSTRACT Foreign bodies (FBs) in the urethra and bladder are a relatively uncommon event. A great variety of FBs have been described most of which were self-inflicted due to autoerotic stimulation, psychiatric disturbances, senility, substance abuse and as a result of iatrogenic causes. We present a case of a married lady with self-inserted eye brow pencil in her urinary bladder due to autoerotic stimulation. Diagnosis was confirmed by imaging studies and urethrocystoscopy and the FB was successfully removed by open cystostomy.
... In most of the cases, the foreign bodies could be removed from the bladder at cystoscopy [1,3,24,26,36]. There are several modifications to minimally invasive methods of removing intra-vesical FBs such as use of nephroscopes, CO2 insufflation cystoscopy, percutaneous access, amplatz sheaths, lasers and lithotripsy [4,37]. ...
Background: Foreign bodies within the bladder pose a challenging urologic problem as a result of their diversity, varied presentation and tailored management. Examples of foreign bodies that have been removed from the urinary bladder include electric wires, glass ampoules, sticks, ball point pens, pencils, safety-pins, hairclips, magnetic balls, intrauterine contraceptive devices (IUCD), gauze pieces, pelvic drains and batteries. Methods: We carried out a retrospective review of patients who were found to have intravesical foreign bodies intraoperatively between January 2017 and December 2018 in Abuja, Nigeria. Results: Five patients were found to have intravesical foreign bodies. There were 4 female and a male patient. The mean age at the time of presentation was 51 years. The aetiology was iatrogenic in all but one patient. There was varied mode of presentation. Plain radiographs and abdominopelvic ultrasonography were useful in diagnosis. Endoscopic removal of the foreign body was successful in 3 patients whilst one patient had a suprapubic cystostomy and another suprapubic cystolithotomy. Conclusion: Our review highlights the importance of educating health care workers on the need to ensure catheters, stents, abdominal drains are removed following their stipulated time of use. Awareness of this rare entity as an important possible differential diagnosis in patient presenting with urologic symptoms is also important.
... The presentation of retained foreign body in the lower urinary tract varies widely although dysuria and haematuria are the most common presentation. 3,5 The severity of the condition depends on the nature of the foreign body and, more importantly, time to medical attention. Early diagnosis and removal of the foreign body are of prime importance. ...
... Late presentation may lead to complications such as recurrent urinary tract infection and urolithiasis or, less commonly, erosion of foreign body to adjacent organs. 5 Presenting time is highly variable, ranging from hours to months. 1 Delay in seeking medical consultation may stem from ignorance, psychiatric illness, or embarrassment. 1 X-ray is often performed but is helpful in identifying only radio-opaque objects. Instead, flexible cystoscopy should be performed early for all patients with suspected retained foreign body in the lower urinary tract, in view of the relative simplicity and low risk of the procedure. ...
... The surgical approach should be individualised. 5 Insertion of foreign bodies into the urethra is predominantly reported in men. Palmer et al 3 reported that 97% of their patients were men during their 15 years' experience of managing self-insertion of urethral foreign bodies and six of their 27 patients had a recurrent history. ...
... A physician should give clear instructions to the recipients regarding periodic check of threads and to alarm once they found it missing which may be an early sign of migration. Apart from IUCD, pessaries and lippi's loop, other foreign bodies may perforate the bladder via vagina, mostly as a result of masturbation injuries [7]. Or after an assault or in psychiatric population. ...
... Once in the bladder, foreign bodies are rarely seen to migrate further. Though bladder tries to evacuate them per urethra with micturition [4], a contrary migration of an intravesical foreign body to vicinity organ is quite uncommon and there is only one such report in English literature where a self inflicted intravsicle foreign body migrated into the retroperitoneum [7]. Urinary bladder, as such works as an ultimate destination in lower abdomen and pelvis, where most of these foreign bodies migrate to lodge and rarely move further. ...
Introduction: Migratory foreign bodies make a separate group of intravesical foreign bodies and any object in vicinity of bladder may migrate into it. Material and methods: Retrospective analysis of migratory intravesical foreign bodies which were treated over last five year, done and discussed with the available literature. Results: Different foreign bodies reported to migrate into the bladder through different route. In most of the cases, they present with minimal lower Urinary Tract Symptoms (LUTS) which are often ignored by patients and clinicians; and it is the haematuria which draw medical attention. With time they encrustate into stone but rarely seen to migrate further. Conclusion: Almost any foreign body in lower abdomen may migrate into urinary bladder through almost any possible route, from where they rarely migrate further. Bladder remains as an ideal receptacle to retain them for long with encrustation.
... The presence of a pen in the urinary bladder is extremely rare and most cases are treated by surgical exploration as this may be due to its long length with increased liability to perforate owing to its sharp tip [10], or the formation of a large bladder stone over a neglected pen cap that requires open cystolithotomy [11]. However, endoscopy was successfully used in the extraction of a piece of pen [12] and fragmentation of a stone encrusted around a pen cover [13]. ...
