臨床膀胱異物取出案例討論
劉瑞文、鐘卓興、鄒凱亦
衛生福利部立雙和醫院 泌尿科
Case report of surprising intravesical foreign body removal
Liu Jui Wen, Chung Cho Hsing, Tsou Kai Yi
Department of Urology, Shuang Ho hospital, Taipei Medical University, Taipei, Taiwan
Introduction: Intraurethra or intravesical foreign body usually cause urinary tract damage, stricture, even perforation and nearly structure injury. Foreign body origins from variety place during daily life or iatrogenic migrating implant. Clinical presentation showed urinary retention, dysuria, frequency, decreasing urine output, hematuria, painful erection. Management should be chosen by character of foreign body, less-invasive method, patient’s comorbidity and condition.
Case report: This 45 years old male patient denied psychological disease history or other chronic disease. He came to our ER because bead pin fell into urethra accidentally while masturbation. He tried using some tool such as tooth pick to pull it out but in vain. Hematuria and urethra pain were also noted. Physical examination showed mild lower abdominal tenderness but no muscle guarding. Lab data showed leukocytosis(12000), other biochemical data was within normal range. Plain film showed about 6cm foreign body within bladder. Operation as endoscopic foreign body removal was done. Needle head initially stabbed into bladder wall about 0.5cm. Needle was pulled out from bladder wall by foreign body forceps without bladder rupture or hematuria. Post-operation antibiotic and intravenous fluid were given. Color of Foley’s catheter was clear. His vital sign and clinic presentation was stable so discharged on the day after operation.
Discussion: After literature review, many case reports about intraurethra and intravesical foreign body were published. It is challenge for urologist to decide clinical management. Endourological management with forceps or grasper, Hol/AYG laser to break is the simplest way for small, non-complicated things. Laparoscopic approaching by tradition way or single site is ideal way for some already perforation body or iatrogenic migrating implant. Open method is altering way for big foreign body or phycian’s choice. No current statistical result showed which method is significant greater outcome than others. But endoscopic management is the most common treatment with high success rate. All case reports showed great outcome and no obvious complication after clinical management. So management should be chosen by character of foreign body, less-invasive method, patient’s comorbidity and condition.
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