輸尿管結石合併罕見膀胱異物:病例報告及文獻回顧

陳冠宇^1,2、王紹全^1,2、謝佐宜^1,2、陳文榮^1,2、宋文瑋^1,2、楊旻鑫^1,2、陳順郎^1,2

¹中山醫學大學附設醫院 泌尿科；²中山醫學大學醫學院

Ureterolithiasis with a rare foreign body in the urinary bladder: a case report and literature review

Kuan-Yu Chen^1,2, Shao-Chuan Wang^1,2, Tuzo-Yi Hsieh^1,2, Wen-Jung Chen^1,2, Wen-Wei Sung^1,2, Ming-Hsin Yang^1,2, Sung-Lang Chen^1,2

¹ Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan;

² School of Medicine, Chung Shan Medical University, Taichung, Taiwan

Introduction: Ureterolithiasis is a common urologic disease with a presentation of flank pain. A foreign body within the urinary bladder may also be reported occasionally. Possible causes of intra-vesical foreign bodies include self-insertion, trauma, or iatrogenic components. Presenting symptoms of the foreign bodies are urinary retention, dysuria, hematuria, nocturia, and pain. When it is related to sexual motivation, patients might feel embarrassed to seek medical help. We presented a case of a rare foreign body in the urinary bladder with dysuria and flank pain symptoms.

Case presentation: A 47-year-old man with a history of urolithiasis. He presented with dysuria and intermittent left flank pain for 5 days. No abdominal pain, fever, chills, nausea, vomiting, decrease in urine output, dysuria, or dyspnea was noticed. Since the symptoms persisted, he came to our emergency department for help. Physical examination showed left costovertebral angle percussion tenderness. Urinalysis showed occult blood: 3+, protein: 3+ , RBC:50-99, WBC≧100 and bacteria:3+. Lab data showed a WBC count of 9900, creatinine of 1.15, and CRP:4.19. Sonography showed left-side hydronephrosis and no visible findings in the bladder. Abdomen CT scan showed a 21mm left upper third ureter stone with severe hydronephrosis, and a 64mm rod-like hypointense object in the urinary bladder. After we inquired about the nature of the object, the patient admitted to pushing an Ethylene-Viny-Acetate made hot melt glue stick into the penis and couldn’t retrieve it. Under the impression of a left ureter stone with hydronephrosis and a foreign body in the urinary bladder, the patient successfully underwent left ureteroscopy lithotripsy and foreign body removal by cystoscopy. No recurrent urinary tract infection, bladder wall tear, or urethral stricture was noticed during outpatient follow-up.

Discussion:

Intravesical foreign bodies by self-insertion are related to sexual gratification, psychiatric disorders, and curiosity^[1]. The incidence was higher in males with a ratio of 1.7:1^[2]. Various objects found in the urinary bladder have been reported in the literature: magnetic balls^[3], a pencil^[4], a screw^[5] and electric wire^[6]. Management of the obstacles includes cystoscopy removal by grasp or basket and suprapubic surgical removal. The postoperative complications incident rate was 22.4%^[1], with the most common complications being recurrent urinary tract infection, bladder wall tear, and urethral stricture. Psychiatric evaluation is recommended in these patients and may reduce the risk of recurrence. Long-term follow-up at the outpatient department is warranted for possible development of urethral stricture.

Conclusion:

This case demonstrated the presentation and management of a patient with a bladder foreign body in a rare clinical scenario. The minimally invasive technique is efficient in the management of most cases. Psychiatric evaluation and long-term outpatient department follow-up are recommended.