小兒泌尿道異物
林毓庭、蕭志豪、溫玉清、李良明、林克勳、林雍偉、石宏仁、許軒豪
台北市立萬芳醫院 泌尿科
Self-Inflicted Urethrovesical Foreign Bodies in 13 year old boy: A case report
Allen Yu Ting Lin, Chi-Hao Hsiao, Yu-Ching Wen, Liang-Ming Lee, Ke-Hsun Lin,Yung-Wei Lin, Hung-Jen Shih
Department of Urology, Wan Fan Hospital, Taipei Medical University, Taipei, Taiwan
Purpose:
We present a case of bladder foreign body of a pediatric patient that repeatedly inserted the object into his urethra for exploratory reason. The bead eventually migrated into bladder which results in repeated urinary tract infection and hematuria. The bead was removed endoscopically without complication. The available literature is reviewed and surgical method is compared.
Case:
This 12-year-old boy is without any significant development delay or medical history. Patient was admitted to the pediatric ward due to dysuria and intermittent hematuria for about 2 weeks despite medical treatment. Patient was treated with oral antibiotics as urinary tract infection was suspect; however, only minimal symptomatic improvement was observed. Thus, further examination was arranged during admission to evaluate for possible etiology. A plain film of the abdomen confirmed the presence of foreign body within the bladder. 19 clumped magnetic rose-gold color ball (0.5cm each) with some coating was noted within urinary bladder and the clumped balls were removed successfully with cystoscope after otis urethrotomy and sounding. Patient tolerated the procedure well and no stenosis was observed during followup evaluation.
Discussion:
We reviewed the available literature with total of three cases: an 11-year-old boy with several magnetic beads in the bladder that was successfully removed with stone basket and grasping forceps; another case of a 12-year-old boy with magnet ball embedded into urethra that was removed with metal swab holder; another case of 16-year-old boy with high strength magnetic ball within urinary bladder that was removed with cystostomy as cystocopic failed.
Conclusion:
The transurethral insertion of magnetic beads is a rare but significant hazardous. From the review of the limited literatures, we conclude that a cystostomy can be one of the treatment options if the transurethral attempt to remove the beads fails and mild dilatation can also be performed to aid in retrieval without significant post-operative consequences.