Abstract
Background
There are many types of foreign bodies in the bladder and urethra. The most common way is to insert foreign bodies through the external urethra by oneself or by others. It is often seen in situations such as masturbation, mental disorder, curiosity, etc. This article discusses the clinical diagnosis and treatment methods and preventive measures for foreign bodies in the bladder and urethra caused by sexual fetishes.
Case presentation
This article introduces a rare case. The patient was a 54-year-old male who inserted a thermometer into his urethra during masturbation and could not remove it. During the operation, we tried various methods to remove the thermometer many times, but due to the angle of the thermometer embedded in the bladder and urethra and the smooth tip of the thermometer, it could not be removed with foreign body forceps. Finally, a homemade negative pressure aspirator (consisting of a section of infusion tube and a 50 ml syringe) was used to completely remove the thermometer from the bladder and urethra. The Written informed consent was obtained from patient did not experience complications such as mercury leakage and bladder and urethral perforation. A telephone follow-up 4 months later showed that the patient urinated smoothly without discomfort such as frequent urination and urgency.
Discussion
There are many types of vesicourethral foreign bodies. When treating vesicourethral foreign bodies clinically, these can be removed through endoscopy, laparoscopy or open surgery according to the size, type and nature of the foreign bodies. At the same time, in order to effectively prevent the occurrence of bladder and urethra foreign bodies, sex education should be vigorously promoted.
Keywords: Vesicourethral foreign bodies, Thermometer, Medical infusion tube
Case presentation
One month before admission, a 54-year-old middle-aged male patient inserted a thermometer into the urethra during sexual masturbation. Subsequently, the patient developed painful urination and a small amount of violent insertion of the sheath may cause. The next day, he experienced frequent urination, urgency, painful urination, and difficulty in urination. The main manifestations were changes in the urinary line. At that time, the patient thought that the thermometer could be discharged on its own, so he did not seek medical treatment. After that, the patient’s symptoms of urgency, frequency, and difficulty in urination gradually worsened, and he also developed perineal pain and discomfort. He then came to our hospital for treatment and physical examination showed that the male genitals appeared normal in appearance, with no redness, swelling or ulcers on the scrotum, and a cylindrical hard protrusion could be felt in the scrotum. The patient had no special medical history. After admission, abdominal CT sagittal image showed a foreign body in the bladder and urethra. Based on the medical history, the diagnosis was a thermometer (as shown in Fig. 1). There were no abnormalities in the relevant preoperative auxiliary examinations. After excluding surgical contraindications, “transurethral the vesicourethral foreign body removal” was performed after subarachnoid anesthesia.
Fig. 1.
Abdominal CT sagittal image: urethral foreign body: thermometer shape (indicated by the red arrow)
During the operation, the paraffin-oil-lubricated urethroscopic sheath (as shown in Fig. 2, the blue arrow) was first inserted into the urethra, and then a 9.8 F ureteroscope was inserted into the urethroscopic sheath. Under the ureteroscope, the metal end of the thermometer was found embedded in the submucosal of the prostate part. In order to avoid the thermometer breaking and causing mercury leakage or the thermometer being completely pushed into the bladder, the urethroscopic sheath could not be forced into the bladder, and the foreign body forcep could not clamp out the smooth thermometer (as shown in Fig. 3). So we decided to hold the urethrascope sheath against the thermometer to prevent it from swinging randomly, and at the same time use a homemade negative pressure suction tube method to remove the thermometer. so we cut a piece of medical infusion tube of suitable length, connected one end to a 50 ml syringe, and put the other end of the medical infusion tube into the urethroscopic sheath by hand under the direct vision of a 9.8 F ureteroscope. We found that the medical infusion tube could just fit into the metal end of the thermometer that had been fixed by the urethroscopic sheath. Then we used a 50 ml syringe to aspirate the medical infusion tube and took out the thermometer by negative pressure suction (see Fig. 2 for the method). The ureteroscope was inserted into the urethra again for exploration, and the bladder and urethra mucosa was found to be intact, with only a small diverticulum in the bladder caused by the thermometer being stuck. A urinary catheter was left in place after the operation and was removed on the first day after the operation. The patient recovered well and was discharged from the hospital. Four months after discharge, we followed up with the patient by phone and found that he had smooth urination and no special discomfort.
Fig. 2.
Homemade negative pressure suction tube (indicated by the red arrow) and urethroscopic sheath (indicated by the blue arrow)
Fig. 3.
The smooth metal end of a thermometer shown in an endoscope
Discussion and conclusions
There are many types of foreign objects in the bladder and urethra. The foreign objects reported in the literature include cups, earphone wires, nylon wires, wires, magnetic beads, plastic tubes, metal springs, intrauterine devices, etc [1–7].
Patients with foreign bodies in the bladder and urethra may experience difficulty urinating, hematuria, frequent urination, dysuria, lower abdominal pain, penile edema, urinary retention, dyspareunia, concurrent infections, stones, urethral stricture, and even upper urinary tract hydrops, renal insufficiency, etc. symptom [8, 9]. The patient in this case inserted a thermometer into the urethra due to some sexual quirks, resulting in a foreign body in the bladder and urethra. He also developed some mild symptoms such as frequent urination, urgency, difficulty urinating, and perineal pain. He did not seek medical treatment in time due to fear, embarrassment, and anxiety, fortunately it did not cause any sequelae.
Foreign bodies in the bladder and urethra need to be removed promptly to avoid a series of complications caused by long-term foreign bodies. Currently, there are three main treatment methods: transurethral cystoscopic foreign body removal, laparoscopic or open surgical foreign body removal, and multi-channel combined foreign body removal: including cystostomy and catheterization, etc [10–12]. The foreign body in the bladder and urethra of this patient was a thermometer. So far, there are few related reports. Because the thermometer contains mercury, it has corrosive health hazards. When the thermometer enters the urethra and bladder, it may cause the thermometer to break and lead to mercury poisoning in the patient. When the patient is mercury poisoned, Symptoms include fever, headache, dizziness, etc. In severe cases, it can damage the lungs, kidneys and central nervous system [13]. The patient in this case had no such symptoms, and CT and abdominal plain film imaging did not indicate that the thermometer broke causing mercury leakage. During the operation, we first thought of inserting a metal urethroscopic sheath into the bladder to facilitate the thermometer to slide out of the urethra along the sheath (as shown in Fig. 2, the blue arrow). However, due to the angle problem, forceful insertion of the sheath may cause bladder and urethra damage or thermometer breakage. Later, we wanted to clamp out the thermometer with foreign body forceps, but because the thermometer has a cylindrical metal head and a vitreous tail, and its surface is smooth, the foreign body forceps cannot directly clamp out the thermometer. In order to avoid open surgery and reduce the risk of thermometer breakage, we finally thought of using a homemade negative pressure suction tube to perfectly remove the thermometer in the bladder and urethra, and let the patient recover and be discharged from the hospital in a short time. This has added a new surgical method for transurethral bladder foreign body removal.
There are many kinds of foreign bodies in the bladder and urethra. Only doctors can’t think of it, but no patients can do it. For foreign bodies in the bladder and urethra, our doctors should formulate the safest, most effective and minimally invasive removal methods for patients according to the size, nature and type of foreign bodies to reduce complications. This article introduces a new surgical method. The thermometer can be completely removed by making a self-made negative pressure suction tube. By analogy, we can make various suitable types of negative pressure suction tubes to remove glass rods, pencils, cylindrical pens and other similar objects. This will improve the surgical efficiency of solving various bladder and urethra foreign bodies in clinical practice. At the same time, in order to effectively prevent the occurrence of foreign bodies in the bladder and urethra, sex education should be vigorously promoted so that the masses can learn more about health knowledge and establish correct sexual concepts.
Acknowledgements
The authors sincerely thank the patient for his contribution to the publication of this case report.
Author contributions
JS and YW, as co first authors, led the clinical management of patients and wrote and edited the manuscript. SF and SL assisted in literature review and conducted detailed proofreading of the manuscript. All authors have read and approved the final manuscript.
Funding
This work was supported by funding from Fujian Medical University Sailing Fund [2023QH1279].
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
Written informed consent was obtained from the patient.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
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Data Availability Statement
No datasets were generated or analysed during the current study.