Bedside Ultrasound in Workup of Self-Inserted Headset Cable into the Penile Urethra and Incidentally Discovered Intravesical Foreign Body

Below:  Patient on initial presentation with headset antenna inserted into the penile urethra. A piece of transparent fishing line was also found to be protruding from the urethral meatus alongside the atenna; however, it is not visible in this figure.

Below:  Plain film demonstrating antenna in penile urethra and radiopaque foreign body within the pelvis. Of note the fishing line with attached beads was not visible.

Below:  Electric wire with calcifications removed by bedside cystoscopy.

"Self-insertion of foreign objects in the lower genitourinary tract is a rare but well-documented occurrence in the urologic literature. There have been multiple cases of sharp objects (hair pins, tweezers, screws, nails, and fish hooks), large objects (AAA batteries, garden hoses, toothbrushes, and ballpoint pens), and organic materials (carrots, cucumbers, bamboo sticks, and leaves) discovered in the urethra and bladder of patients presenting to the emergency department [1–7]. While some patients may provide an accurate history and exhibit visible pathology on examination, many patients will present with nonspecific symptoms and provide poor histories due to either embarrassment or limited mental capacity [4, 8–10]. Subsequently, a high index of suspicion must be maintained in order to properly diagnose and manage patients with self-inserted foreign objects. We present a case of a developmentally delayed 64-year-old male with a month-long history of recurrent urinary tract infections. He presented to the emergency department with fishing line and a black electrical cable inserted into his penile urethra with an intact headset attached externally. Prompt bedside ultrasound revealed a second radioopaque object in the bladder. An anesthetic penile block was performed to facilitate removal of the fishing line and cable with gentle traction, followed by a bedside cystoscopy to retrieve a separate intravesicular coil of copper wire. All foreign bodies were safely removed without complications. The patient was subsequently discharged with a five-day course of prophylactic antibiotics. We suggest implementing bedside ultrasound as a quick, low-cost, and effective initial screening tool to evaluate all patients presenting with urethral foreign bodies to help rule out the possibility of additional objects in the urinary bladder."

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