#0439

Management of Self-Inserted Foreign Bodies in the Lower Urinary Tract: A Case Series and Literature Review

W. Chen^1,2, P. Hsieh², S. Lai¹, T. Huang¹, C. Mei^1,2, K. Chung¹, Z. Lin¹, J. Li²

¹Taichung Veteran General Hospital, Division of Traumatology, Department of Emergency Medicine, Taichung, Taiwan
²Taichung Veteran General Hospital, Department of Urology, Taichung, Taiwan

Introduction:

The insertion of foreign bodies into the lower urinary tract, often self-inflicted, poses a diagnostic and therapeutic challenge. Patients may present with dysuria, hematuria, or urinary retention, and cases often involve psychiatric comorbidities. Management strategies range from conservative extraction techniques to open surgical interventions, depending on the object’s characteristics and location. This study aims to provide insight into effective management by reviewing four cases treated at our hospital alongside a review of recent literature.

Material and methods:

(Case Series) Case 1: Rubber Tube A 54-year-old male presented to the emergency department after inserting a 1-meter-long rubber tube into his urethra, leaving 20 cm externally visible. Under general anesthesia, cystoscopy revealed the tube was knotted. Cystoscopic scissors were used to cut and remove it. The patient had an uneventful recovery. Case 2: Electrical Wire Sheath A 19-year-old male inserted the outer casing of an electrical wire into his urethra and presented the following day with urinary discomfort. KUB imaging confirmed a long foreign object in the bladder. Under local anesthesia, cystoscopy was performed, and the object was successfully removed with forceps. Case 3: Thermometer A 15-year-old boy with moderate intellectual disability inserted an aquarium thermometer into his urethra. The next day, he developed dysuria and informed his caregiver. X-ray confirmed the foreign object in the bladder. Cystoscopic removal was performed under general anesthesia, and he was discharged without complications. Case 4: Indwelling Catheter A 34-year-old female with schizophrenia was hospitalized in a psychiatric ward. She had self-inserted an indwelling catheter into her urethra, which became lodged. Under local anesthesia, the catheter was identified and successfully removed. She was returned to psychiatric care for further management.

Results:

(Literature Review) The literature reveals a wide spectrum of foreign bodies reported in the urinary tract, including wires, batteries, and household objects. Radiological imaging, particularly computed tomography (CT), is crucial for localization and surgical planning. Endoscopic retrieval remains the preferred approach, though open surgery may be necessary for large or entangled objects. Psychiatric evaluation is recommended in recurrent cases. (Discussion) Management of urinary foreign bodies requires a tailored approach. The use of minimally invasive techniques, such as cystoscopic extraction, is often effective. Imaging guides decision-making, and psychiatric support is essential for cases with underlying behavioral health concerns. Our series underscores the importance of timely intervention and individualized patient management.