Urethral foreign bodies: a hidden consequence of autoerotic behavior—a case report

Abstract

Background

Urethral foreign body insertion is a rare clinical condition and is often associated with autoerotic behavior or psychiatric disorders. This case is notable due to the unusual nature of the inserted object—a tree branch—and the absence of previously diagnosed psychiatric illness. It contributes to the literature by emphasizing the clinical, psychological, and procedural considerations required for effective management.

Case presentation

A 24-year-old married Yemeni man presented with a two-day history of dysuria and urinary frequency following the self-insertion of a tree branch into his urethra for sexual stimulation. Physical examination revealed a firm mass in the mid-shaft of the penis. Urinalysis showed microscopic hematuria and pyuria. The diagnosis of a urethral foreign body was confirmed by imaging (ultrasound and KUB X-ray), which revealed a 9 cm rod-like object extending from the mid-penile urethra to the prostatic urethra. Under general anesthesia, cystoscopic removal of the foreign body was performed successfully. A small urethral tear was noted, for which a Foley catheter was inserted and left in place for one week to promote healing. The patient recovered without complications and was discharged the same day.

Conclusion

This case underscores the importance of early diagnosis and minimally invasive management in patients presenting with urethral foreign bodies. It also highlights the need for psychological evaluation to address underlying behavioral causes. Clinicians should maintain a high index of suspicion in similar presentations and ensure a multidisciplinary approach involving both urological and psychological care.

Introduction

Urethral foreign body insertion is a urological emergency involving the introduction of objects into the urethra. While uncommon, several reported cases exist, with insertion motives ranging from curiosity to autoerotic stimulation or medical procedures [1]. The nature of foreign bodies varies widely, from wires, screws, or ballpoint pens to even animals like snakes [2]. While some foreign bodies may remain asymptomatic for extended periods, many cases present with severe pain, hematuria, and urinary tract infections [3]. In this report, we detail a case involving a self-inserted foreign body (a tree branch) in the lower urinary tract, illustrating symptoms such as pain, bleeding, urinary difficulties, and retention. Without timely intervention, urethral foreign bodies can lead to complications such as infections, urethral strictures, and bladder perforation [1–3].

This is a highly unusual case because it involves the self-insertion of a tree branch into the urethra by a young adult male with no known psychiatric history. While urethral foreign body insertion is rare, it is most often linked to autoerotic behavior, psychiatric illness, intoxication, or sexual experimentation. The unusual choice of object and the absence of prior mental health diagnosis make this case noteworthy. It adds to the growing body of literature emphasizing the clinical challenges, potential complications, and the importance of both prompt endoscopic removal and consideration of psychological assessment in such patients [1–3].

Case presentation

Patient information

In October 2024, a 24-year-old married Yemeni man presented with a two-day history of a retained foreign body in his urethra. He reported both urinary frequency (increased urination) and dysuria (painful urination). The patient stated that he had self-inserted a tree branch into his urethra for sexual stimulation. He sought medical care after being unable to remove the object on his own. On further questioning, he admitted to a history of using foreign objects for self-stimulation a few times in the past, with successful removal on those occasions. However, this time, removal was unsuccessful, prompting medical attention.

Clinical findings

On physical examination, the patient was afebrile with stable vital signs. Abdominal examination revealed no suprapubic tenderness or palpable masses. External genital examination demonstrated a firm, well-defined mass palpated along the mid-portion of the penile shaft, without evidence of meatal bleeding, discharge, or external trauma. Laboratory investigations revealed microscopic hematuria and pyuria on urinalysis, while the electrolyte profile and complete blood count were within normal limits. Ultrasound imaging demonstrated an abnormal echogenic structure extending from the mid-pendulous urethra distally to the prostatic urethra proximally.

Timeline

A chronological summary of the patient’s presentation, diagnostic workup, management, and follow-up is outlined below. This will also be provided as a formatted table in the full manuscript.

Date / timeframe	Event / clinical findings	Interventions / outcomes
Day 0	Patient self-inserts a 9 cm tree branch into the urethra for sexual stimulation	No intervention attempted initially
Day 2	Presents to urology clinic with dysuria and urinary frequency	Physical exam, urinalysis, ultrasound, KUB X-ray performed
Same day	Diagnosis: Urethral foreign body with small urethral tear suspected	Planned for operative intervention
Same day	Under general anesthesia, cystoscopic removal of the foreign body performed; Foley catheter inserted for 1 week	Immediate symptom relief
1 week later	Follow-up cystoscopy to confirm urethral healing	Foley catheter removed; no complications noted
Post-procedure	Referral for psychological evaluation	Patient referred but compliance uncertain

Diagnostic assessment

The diagnosis was made using a combination of physical examination and imaging modalities. On examination, a firm, elongated mass was palpated in the mid-portion of the penis. Ultrasound of the penis and urethra revealed an echogenic linear structure extending from the mid-pendulous urethra proximally toward the prostatic urethra. A plain KUB X-ray confirmed the presence of a radiopaque, rod-shaped foreign body measuring approximately 9 cm in length and 10 French in diameter.

The primary diagnosis was a urethral foreign body—a tree branch—confirmed by imaging findings. The main diagnostic challenge was assessing the exact position and potential migration of the object toward the bladder, as well as determining the extent of urethral injury prior to removal. Despite these concerns, the prognosis was favorable given the absence of systemic infection, minimal urethral trauma, and prompt endoscopic intervention followed by short-term Foley catheterization (Fig. 1).

Fig. 1.

Abnormal shadowing (black arrow) were observed from penile and reach to bulbar urethral on plain KUB film

Therapeutic intervention

The patient underwent surgical management in the form of cystoscopic removal of the foreign body under general anesthesia. A rigid cystoscope was gently introduced into the urethra, allowing direct visualization of the rod-shaped tree branch lodged from the mid-pendulous to the proximal urethra. The object was carefully grasped with foreign body forceps and removed intact, minimizing mucosal trauma (Fig. 2).

Fig. 2.

Foreign body a rod-shaped material 9 cm long and 10 Fr in diameter (a branch of a tree) after remove from male urethra

Following removal, cystoscopic inspection revealed a small urethral tear at the proximal end of the object’s location. To promote healing and prevent urethral stricture formation, a 16 Fr Foley catheter was inserted and left in situ for one week. No intraoperative complications occurred, and the patient tolerated the procedure well.

Follow-up and outcomes

The patient experienced full recovery without any immediate or delayed complications. He was discharged home the same day following the procedure with a Foley catheter in place and was provided with instructions for catheter care. At one-week follow-up, a repeat cystoscopic examination confirmed complete healing of the small urethral tear, and the Foley catheter was removed without incident.

The patient was advised to undergo further follow-up to monitor for potential late complications such as urethral stricture formation. He was also referred for psychological evaluation to address the underlying behavioral factors contributing to his self-insertion of foreign objects; however, compliance with this referral remains unknown.

No adverse events or unanticipated outcomes were reported during the perioperative period or short-term follow-up.

Discussion

The urethral foreign body was successfully removed in this instance with little harm because to prompt action. The patient's denial of psychiatric follow-up, which is crucial for treating underlying behavioral problems and preventing recurrence, was the main restriction. To reduce problems including infection, stricture formation, and tissue damage, the medical literature consistently supports the early cystoscopic removal of urethral foreign bodies [1–3].

Electric wires, thermometers, hairpins, toothpicks, eyeglass rims, straws, pencils, paperclips, and fishhooks are just a few of the many foreign objects that have been documented in the lower urinary tract [4]. There have also been reports of other strange objects, including fish, snakes, plastic tubes, metallic wires, and paraffin [5]. Psychological illnesses, trauma, migration from other organs, and iatrogenic factors during urological treatments are among the reasons of foreign body introduction [5]. Among them, the most frequent causes of self-insertion are erotic or sexual motivations, such as masturbation or sexual experimentation, followed by curiosity, behavior connected to intoxication, and a variety of mental disorders [4, 5].

Self-inserted foreign bodies usually enter through the urethra [2]. The object may migrate proximally into the bladder as a result of manual removal attempts or involuntary spasms of the perineal muscles. It is conceivable for an adult male with an erect penis to migrate 20–25 cm from the meatus to the bladder [5]. Notably, although this mechanism is still poorly understood, migration through the bulbous urethral curvature can happen without significant harm [5]. Extraction gets more difficult when the object moves in close proximity and cannot be manually retrieved [6].

Since these cases are uncommon, a complete history and physical examination are necessary to determine the kind of object and length of insertion. To ascertain size, quantity, and location, radiologic evaluation is essential [4]. Pelvic radiography is usually adequate for localization; computed tomography or ultrasonography may be used if results are unclear or problems are suspected [5].

Because they lessen urethral and bladder stress, minimally invasive techniques such endoscopic retrieval are the recommended removal technique [1, 2, 7, 8]. Open surgical procedures like suprapubic cystostomy or perineal urethrotomy may be necessary when endoscopic techniques are unsuccessful, such as when dealing with large, sharp, or encrusted materials [7, 8].

Mucosal tears, strictures, urinary tract infections, hematuria, and persistent dysuria are possible side effects of urethral foreign body insertion [9]. In this instance, fast identification and cystoscopic removal were made possible by early medical treatment after self-insertion. Even though there was a tiny urethral rupture, the Foley catheter was inserted for a week to promote healing and stop additional damage. In accordance with best practice standards, the patient was recommended to have a psychiatric consultation; however, this follow-up was denied.

Conclusion

In conclusion, it is not unusual for a foreign body to be inserted into the lower urinary tract for erotic purposes, particularly among men. A urological emergency, urethral foreign body insertion can result in serious side effects, such as urethral damage. The first line of treatment should be early detection and endoscopic removal of the foreign body, which has a high success rate. Complications from delayed presentation may necessitate additional imaging tests and more involved surgical techniques. It also emphasizes the significance of treating these behaviors with psychiatric examination and treatment, as well as the possible involvement of underlying psychological problems.

Author contributions

Nasser Albaddai: Conceptualization, patient management, manuscript writing. Ahmed Farei: Clinical investigation, manuscript review. Abdullah Al-Sakkaf: Literature review, editing, and supervision. Wael Alsaqaf: Data interpretation and manuscript editing. Aziz Shamsan: Figure preparation, manuscript formatting, and references. All authors read and approved the final manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

All relevant data generated or analyzed during this study are included in this published article.

Declarations

Ethics approval and consent to participate

Not applicable. Ethical approval was not required for this single-patient case report, in accordance with local regulations. The patient provided informed consent for the clinical procedure and for inclusion in this publication.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.