Autoerotism and foreign body bladder

Dear Sir,

Urinary bladder (UB) foreign bodies are commonly encountered following iatrogenic injuries, self-insertion, sexual abuse, or assault.¹ It is difficult to obtain reliable history from a patient inserting object for sexual gratification or curiosity. Fear of embarrassment leads to late presentation at hospital and patient trying to conceal the history.²

We present a case of a male patient in his early 40s who reported with 2 days history of lower abdominal pain, painful micturition, and hematuria. There was no history of fever or any evidence suggestive of urosepsis or any signs of peritonism. However, the patient admitted that he had inserted a lead pencil per urethra using petroleum jelly for the sexual gratification or autoerotism. Following this event, he complained of the current symptoms. Physical examination revealed no significant findings. The routine blood test and biochemistry parameters were within normal limits. Urine microscopy showed numerous red blood cells (RBCs), epithelial cells, and few pus cells. Radiograph Kidney, Ureter, and Bladder (KUB) showed linear opacity lying vertically in midline in the pelvis (Fig. 1A). Suprapubic cystotomy was done under spinal anesthesia, and the foreign body (FB) was removed (Fig. 1B). Postoperatively, Foley’s catheter was kept in situ for 10 days, and the whole postoperative period went uneventful.

Fig. 1.

(A) Radiograph of abdomen erect with the pelvis shows a radiopaque linear foreign body lying vertically in the pelvis, (B) Shows the removal of a lead pencil after suprapubic cystotomy.

FB insertion in the UB has been documented in literature; still there are challenges in its diagnosis and management. The FB may enter the bladder by various means such as iatrogenic insertion, migration, and via penetration.^3,4 Self-insertion is commonly seen for sexual gratification, psychiatric disorder, or after drug abuse. A wide range of objects like wooden sticks, lead pencils, wires, chicken bones, beads, kidney beans, ball-point pens have been documented to be found in the UB.² These FBs may lead to obstructive and/or irritative symptoms including symptoms like hematuria, urinary tract infections, urosepsis, or peritonitis.^{3, 4, 5} Sharp objects after penetrating the bladder wall may migrate to the peritoneal cavity and damage vital structures leading to acute peritonitis.⁵ Insertion of an FB in the UB is commonly seen in females due to short and straight urethra, whereas in males, it is long and curved.

Management depends on the size of the FB, its mobility in the lumen, duration of insertion, and associated complications. The FB can be retrieved by either open or cystoscopic methods. In our case, open surgery was preferred due to the large size of the FB and due to its location in the UB. Patient consent for inclusion of images in the study was obtained.

To conclude, urinary bladder foreign bodies have been witnessed since ages. It is the lack of awareness and outcome of insertion, which needs to be impressed. Differential diagnosis of FB in the UB should be kept in mind in young adolescent, unmarried individuals, and forced bachelors presenting with lower urinary tract symptoms (LUTS). Sexual gratification, curiosity, and lack of sex education can be inciting factors for such misadventurous acts. Due to the fear of embarrassment, it is important to maintain confidentiality and build rapport and trust with the patient to gain vital history so that management can be tailored as per the symptoms and size of the FB.

Patients/ Guardians/ Participants consent

Patients informed consent was obtained.

Ethical clearance

Not Applicable.

Source of support

Nil.

Disclosure of competing interest

The authors have none to declare.