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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 104-106

Intravesical foreign body: The forgotten and forsaken diagnosis? a case report and review


Department of Urology and General Surgery, Jordan University of Science and Technology, Irbid, Jordan

Date of Web Publication28-Sep-2017

Correspondence Address:
Radwan Khalid Al-Okour
Department of Urology and General Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, P. O. 22110, Irbid 00962
Jordan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jina.jina_11_17

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  Abstract 


Intravesical foreign bodies are rarely encountered in the practice of urology; they are the exception rather than the rule. Radiological imaging plays an important role in the diagnosis and management as it helps to determine the size, shape, number of foreign bodies as well as the possible complications. Treatment should aim to the removal of the foreign bodies and avoid complications whether by endoscopic or open approaches. Here, we present a case of a female child presented with chronic urinary symptoms found to have intravesical foreign with encrustation.

Keywords: Chronic urinary symptoms, foreign body encrustation, intravesical foreign body


How to cite this article:
Al-Okour RK, Al-Ghawanmeh HM, Al-Ghazo M. Intravesical foreign body: The forgotten and forsaken diagnosis? a case report and review. J Integr Nephrol Androl 2017;4:104-6

How to cite this URL:
Al-Okour RK, Al-Ghawanmeh HM, Al-Ghazo M. Intravesical foreign body: The forgotten and forsaken diagnosis? a case report and review. J Integr Nephrol Androl [serial online] 2017 [cited 2020 Jul 4];4:104-6. Available from: http://www.journal-ina.com/text.asp?2017/4/3/104/215736




  Introduction Top


Intravesical or intraurethral foreign bodies usually result from iatrogenic injuries, self-insertion, sexual abuse, assault, and migration from adjacent sites. The symptoms are usually related to bladder irritation. High index of suspicion should be maintained and Imaging plays an important role in the diagnosis. Foreign bodies should be suspected in patients with unexplained chronic irritative symptoms.


  Case Report Top


A 14-year-old female student with a history of the right ureteric reimplantation for grade III vesicoureteric reflux (VUR) in 2010 was doing fine till she presented in January 2016 complaining of 3-month history of lower abdominal pain. The pain was dull in nature, nonradiating and associated with burning sensation upon micturition, frequency, urgency, urge incontinence, and sense of incomplete void along with gross total hematuria with clots. She had been admitted many times at another hospital for recurrent urinary tract infections (UTIs) and had been evaluated with ultrasound (US), and Micturating cystourethrogram (MCUG) showing intravesical calcifications and grade II VUR at the left side, respectively. She was then referred to our institution for evaluation. Examination revealed right lower abdominal scar of previous reimplantation and mild tenderness on deep palpation in the lower abdomen. Urine analysis revealed full over the slide white blood cells and X-ray kidney, ureter, and bladder (XR KUB) showed a calcified foreign body in the urinary bladder [Figure 1].
Figure 1: Calcified intravesical foreign body

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In January 2016, after counseling the family, the patient underwent diagnostic cystoscopy showing intra-vesical encrusted foreign body [Figure 2], this was followed by open cystotomy and foreign body extraction. On removal of the encrustation, the foreign body was found to be a hairpin. The child did not show any evidence of psychiatric illnesses. The postoperative period was unremarkable, and she was discharged on the 4th day postoperatively. On follow-up, the patient had wound infection and admitted later for intravenous antibiotics. She was then discharged and to be followed up. Her last visit was in January 2017, and the patient is doing fine with resolved symptoms.
Figure 2: Endoscopic appearance of encrusted foreign body

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  Discussion Top


Intravesical foreign bodies are rarely encountered in the practice of urology; they are the exception rather than the rule. A variety of objects were reported in the literature including electric cable, paper clips, cotton swabs, tampons, and others. Literature suggests almost any conceivable object has been introduced into the urinary bladder.[1] Intravesical or intraurethral foreign bodies usually result from iatrogenic injuries, self-insertion, sexual abuse, assault, and migration from adjacent sites, although migration from adjacent sites is rare.[2] Self-insertion usually occurs while seeking sexual pleasure, in patients on clean intermittent catheterization and in patients with psychiatric illness.

The symptoms of intravesical foreign bodies are usually due to bladder irritation, reduced bladder capacity or related to complications. Hematuria may occur from trauma due to self-manipulation or rough objects that injure the bladder wall.[3] The complications vary from acute to chronic and include acute cystitis, urethral strictures, chronic lower urinary tract symptoms, recurrent UTIs, urine retention, encrustation of the foreign body, and calcifications along with serious complications as vesicovaginal fistulas, scrotal gangrene, bladder perforation, migration to the peritoneum, and life-threatening sepsis.

The presence of foreign body in the bladder should be considered in the differential for patients who present with recurrent infections and chronic urinary symptoms. Accurate history is of crucial importance, even though patients may be embarrassed or humiliated to admit self-insertion especially in cases of sexual pleasure or abuse and may be the reason for the late presentation. Signs that should raise the physician's suspicion include undue anxiety during sexual history taking or attempts to avoid genital or rectal examination.[4]

Radiological imaging plays an important role in the diagnosis and management of such cases as it helps to determine the size, shape, number of foreign bodies as well as the possible complications. XR KUB helps detect radiopaque objects. US and computed tomography imaging might help detect radiolucent imaging. However, urethrocystoscopy is usually used for confirmation and in some studies, has been considered the most accurate method for diagnosing foreign bodies in the urinary bladder.[2]

Treatment should aim to the removal of the foreign bodies and avoid complications. Methods of extraction vary according to the size, shape, nature of the foreign body, the available instruments and the surgeon's experience. However, each foreign body poses a challenge to the urologist and treatment has to be individualized according to the size, the nature of the foreign body and the age of the patient.[1]


  Conclusion Top


The presence of foreign body in the bladder should be considered in the differential for patients who present with recurrent unexplained lower urinary tract symptoms. Treatment should be individualized according to the case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rafique M. Intravesical foreign bodies: Review and current management strategies. Urol J 2008;5:223-31.  Back to cited text no. 1
[PUBMED]    
2.
Bansal A, Yadav P, Kumar M, Sankhwar S, Purkait B, Jhanwar A, et al. Foreign bodies in the urinary bladder and their management: A single-centre experience from North India. Int Neurourol J 2016;20:260-9.  Back to cited text no. 2
    
3.
Irekpita E, Imomoh P, Kesieme E, Onuora V. Intravesical foreign bodies: A case report and a review of the literature. Int Med Case Rep J 2011;4:35-9.  Back to cited text no. 3
    
4.
Dardamanis M, Balta L, Zacharopoulos V, Tatsi V, Tzima H. An Unexpected Foreign Body (a Thermometer) in the Bladder: A Case Report. Urol Case Rep 2014;2:65-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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