陳宏睿、丁慧恭、卓育慶、吳勝堂、查岱龍、孫光煥、于大雄

三軍總醫院 外科部 泌尿外科

Hong-Ray Chen, Hui-kong Ting, Yu-Cing Juho, Seng-Tang Wu, Guang-Haun Sun, Tai-Lung Cha, Dah-Shyong Yu

Division of Urology, Departments of Surgery, Tri-Service General Hospital,

National Defense Medical Center, Taipei, Taiwan, Republic of China

 

Purpose: Plants in urethra was hard to see, and there was no case report in human until now. We showed an special case about this.

Materials and Methods: This report is to present a rare case with intraurethral budding. A 56 year-old male voided one budding about 3cm in length from the urethra, accompanied with one dark-brown colored stone with 1.1 cm in size at one day.

Results: The most possible way was retrograde implant the plant seed into the urethra initially and ureteral stone blocked the urinary outlet when it passed into the bladder from the ureter which lead to the subsequent budding and growth of seed in the urethra.

Conclusion: We present an unusual case of impacted bladder stone accompanied with urethral plant seeding incidentally, and it was also the first case been reported in human.

A 56 years-old male had knowing history of left renal stone without regular follow up for 2 years. He had episode of renal colic on August 1, 2013 and he went to our emergency room for help, where abdominal x-ray showed stone on left renal and lower third ureter. There was no obvious hydronephrosis and he received conservative treatment. Although lower urinary tract symptoms were noted sometimes, he didn’t pay much attention to them and didn’t go back to our hospital. From July to September, 2015, frequency, urgency, dysuria, and weak stream were more obvious. During this period, he cleaned his potted and plants in his own garden during rainy day without wearing raincoat but briefs on August 9. On September 19, 2015, one budding about 3cm in length was passed out from the urethra, accompanied with one dark-brown colored stone with 1.1 cm in size (Figure 1). Then he came to our clinic and abdominal x ray showed his left ureteral stone disappeared (Figure 2). There were no lower urinary tract symptoms again after he passed out the plant and stone. He even cropped this plant stems and it lived for about 2 months.

Most foreign bodies in the human lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated [1, 2]. Plants in urethra was hard to see, and there was no case report in human until now, but some cases at animal. It was also rare in animal which had foreign body in urinary tract [3-7], and it account about 0.25% in Minnesota Urolith Center research [3, 7]. There was three routes which objects arriving in urinary bladder: first, by iatrogenic mechanisms. Second, though a transabdominal route. Third, through retrograde movement from urethra [3, 6]. Our patient didn’t have cystoscopic examination, Foley catheter insertion, or other operation for few years, so there was no possibility via the first or second mechanism. The most possible way was retrograde implant the plant seed into the urethra initially and ureteral stone blocked the urinary outlet when it passed into the bladder from the ureter which lead to the subsequent budding and growth of seed in the urethra.

     We present an unusual case of impacted bladder stone accompanied with urethral plant seeding incidentally, and it was also the first case been reported in human.