A Rare and Unusual Case of Urethral Bleeding

A 46-year-old man presented with urethral trauma following the unusual sexual practice of urethral sounding. He was able to urinate freely and was treated conservatively. He did not require any follow-up. Urethral sounding is uncommon sexual practice, where commonly a metal object is inserted per urethra for gratification. This practice is actively discouraged because of the long-term risks from urethral trauma.

This case highlights a very unusual cause of urethral bleeding and is very rarely encountered, and not, in recent memory, at this teaching hospital urology department.

Although the literature has highlighted the clinical challenges of inserted objects through the urethra and the clinical challenges of removal, this case brings to the forefront a lifestyle choice that has considerable and significant urological morbidity. A significant proportion of people use this practice. It is also a very poorly researched area, with only a handful of relevant literature.

A 46-year-old man presented to the emergency department of urology with urethral bleeding. On questioning, the bleeding was found to be the direct result of the sexual practice of urethral sounding. He was able to pass water freely and a pelvic x-ray did not reveal any retained metal products in his bladder or urethra. There was no indication for catheterisation to tamponade any urethral bleeding and so he was treated conservatively. He was actively discouraged from continuing this practice. A week later, he said that bleeding had completely stopped a few days earlier and that he was asymptomatic. It was decided that there was no need to follow-up the patient with any further investigations such as flexible cystoscopy...

Full article at: http://goo.gl/r8WAbj

By: Tsong Kwong and Tim Larner

Department of Urology, Royal Sussex County Hospital, Brighton, UK

  

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‘Putting lead in your pencil’: Self-insertion of an unusual urethral foreign body for sexual gratification

Self- insertion of foreign bodies into the urethra and bladder, usually for sexual gratification and auto-eroticism especially during male masturbation, is an unusual but important condition which urologists will encounter.1 Patients thereafter usually feel embarrassed and tend to avoid seeking immediate medical help.2The urological consequences of this type of behaviour can be significant and the implications for patients can be serious including death from sepsis.3,4 Over the last decade, reports in the literature of self-inserted intra-vesical and intra-urethral foreign bodies have increased. We present a case of self-insertion of household batteries into the urethra for sexual pleasure during masturbation. We review possible motives for insertion of foreign bodies in to the urethra and discuss clinical presentation, as well as diagnosis and management of such patients.

Below:  Pelvic radiograph showing two batteries in the urethra

Below:  An endoscopic view of the batteries prior to their removal

Read more at:  http://ht.ly/ScU1D 

By: Nishant Bedi, Tamer El-Husseiny, Noor Buchholz, and Junaid Masood
Department of Urology, Bart's and The London NHS Trust, London, UK

Delayed Diagnosis of an Intraurethral Foreign Body Causing Urosepsis and Penile Necrosis

Cases of self-inserted foreign bodies in the male urethra and urinary bladder are unusual. In most cases, the type of foreign body can be identified by taking a history or from radiological findings; sometimes, however, it is difficult to identify the foreign body because of decreased mental capacity of the patient or unknown radiological characteristics of the foreign body. We experienced a chronic alcoholic patient with septicemia and penile necrosis in whom a fragment of mirror glass had passed through the urethra into the bladder. The glass, 2 cm in length and 0.7 cm in diameter, was detected by cystoscopy and was removed by using a resectosope.

Below:  (A) Follow-up CT shows a newly detected hyperdense lesion inside the bladder. (B) Cystoscopy shows an intravesical 2×0.7 cm glass particle.

Below:  A necrotic lesion of the penile glans

Below:  Abdominal computerized tomography (CT). (A) CT was suggestive of a right retroperitoneal abscess, and (B) a needle-like radiopaque lesion between the rectum and bladder.

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By:  Eu Chang Hwang, Jun Seok Kim, Seung Il Jung, Chang Min Im, Bu Hyeon Yun, Dong Deuk Kwon, Kwangsung Park,Soo Bang Ryu, and Jun Eul Hwang1
1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

Endoscopic Management of Genitourinary Foreign Bodies

Below:  A 30°; camera inserted into the bladder in Patient 1 revealed multiple metallic beads.

Below:  In all, 82 beads measuring a total of 38 cm in length were removed from Patient 1.

Below:  Heavy gauge wires, a safety pin, and an unknown radio-opaque object were seen in a pelvic radiograph of Patient 3.

Below:  Due to the magnetic nature of the beads, many of the beads in Patient 1 were removed as a series.

Below: A magnetic snap found on pelvic radiograph during a return visit of Patient 4.

Retrieval of foreign bodies from the genitourinary system, most commonly inserted for sexual satisfaction or as a result of a psychiatric illness, can pose a significant surgical challenge. Due to their breadth of size, shape, and location within the genitourinary system, endoscopic management can be difficult. Here, we review the management of four cases of foreign object insertion into the genitourinary system and their outcomes and management.

Read more at:  http://ht.ly/S0oGs

By: Joseph B Song, BS, Youssef S Tanagho, MD, MPH, Mohammed Haseebuddin, MD, Brian M Benway, MD, Alana C Desai, MD, Sam B Bhayani, MD, and Robert S Figenshau, MD
Division of Urology, Washington University School of Medicine,, St. Louis, MO

Two Young Men Who Complained of Voiding Difficulty After Stuffing Odd Materials Into the Urethra to Obtain Sexual Gratification

Below: (A) The distal segment of a thick and semirigid electrical cable protruding through the meatus. Its tip was tied to prevent further advancement into the urinary bladder. (B) A plain pelvic radiograph revealing a long radio-opaque object, which had twisted multiple times to form a coiled refractory structure in the pelvic cavity.

Below: (A) A plain pelvic radiograph revealing what appeared to be two radio-opaque bars and one circular foreign body in the pelvic cavity of the patient. (B) Two metallic cylinders and one circular magnet stuck together in the urinary bladder are identified using cystoscopy.

The self-insertion of foreign bodies into the urethra to obtain sexual gratification is an uncommon paraphilia and may be complicated by their passage into the urethra and subsequent difficulties in recovering the foreign body. There are two key areas of discussion in relation to this issue: (1) the psychological aspects of the action and (2) the possible treatment options. With careful attention to the patient's history, it is usually possible to identify the foreign body and the time since insertion. In most cases, the individual seeks emergency surgical treatment. Radiological evaluation is necessary to determine the exact size, location, and number of objects. Endoscopic retrieval is usually successful, but open surgical removal is required in some cases. We present two cases of self-insertion of foreign bodies into the urethra.

Via: http://ht.ly/S0fIj 

By: Sungwoo Hong and Hyung Jee Kim

Department of Urology, Dankook University College of Medicine, Cheonan, Korea.

Unusual Foreign Body in the Vesico-Urethral; 195 cm Liquid Pipe

Insertion of foreign bodies into the genitourinary system is a pathological action believed to increase sexual gratification usually for psychiatric patients and mentally retarded cases especially during masturbation. In this report, we represented a male case who is inserted a 195 cm cannula by himself into the bladder through the urethra because of his psychiatric disorder.

Below:  A long, and thin cannula with a knot protruding from the urethral meatus

Below: Intravesical cannula with multiple knots as seen on CT

Below:  Extracted foreign substance; A 195 cm-long soft plastic cannula with a diameter of 0.5 cm

Read more at:  http://ht.ly/RXzex

By: Doğukan Sökmen, Buğra Doğukan Törer, Taner Kargı, Abdullah Hızır Yavuzsan, Selçuk Şahin, and Volkan Tuğcu

Department of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Correspondence: Doğukan Sökmen, Department of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Retained Self-Inserted Foreign Body into the Urethra Associated with Sequela Urethral Stenosis: A Case Report

Below:  The photo shows the scar resulting from self-inflicted penile strangulation

Below:  Plain film of the urinary tract showing a hollow tubular object corresponding to a cable in the urethra

Below:  The photo shows the actual length of the cable, which measured 25cm.

We report a case of self-insertion of an electric cable into the urethra by a 36-year-old Caucasian man for erotic reasons. The patient, who has an ambiguous history of self-inflicted penile strangulation in childhood and self-insertion of foreign bodies into the urethra in recent years but no psychiatric history, presented to the emergency department to remove the object introduced one week previously. He was - strangely - asymptomatic and presented neither dysuria nor urinary incontinence or hematuria. A physical examination revealed a penile scar corresponding to the strangulation and a palpable hard, thin mass in the perineal urethra. The biologic findings were normal. Plain film of the urinary tract showed a hollow tubular object, whose size and shape corresponded to those of the urethra. Rigid cystoscopy was performed, which revealed urethral stricture at the projection of the scar. Laborious urethrotomy was performed before reaching the 25cm long cable, which was found in the urethra and removed with difficulty due to stenosis.



Via:  http://ht.ly/RxqlK HT https://twitter.com/NCBI

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."

Read more at: http://ht.ly/RxpWa HT https://twitter.com/NCBI

Tongue Cleaner, An Unusual Foreign Body in the Urethra: A Case Report

Below:  Radiograph of pelvis and upper thigh depicting the foreign body with approximately half of its length inside the urethra and a loop at the inserted end

Below:  An intra-operative image depicting the vertical perineal incision and the looped inserted end (Black Arrow) perforating through bulbar part of urethra and the other end of the tongue cleaner (White Arrow)

A foreign body in the lower urinary tract in males is rather uncommon but several cases of insertion of foreign bodies such as pins, wires, screws or ball point pens have been reported. The most common causes of such incidents are psychiatric illness or intoxication, and autoerotic stimulation. Most cases occur in adult males. We report a single case of a patient who inserted a metallic tongue cleaner, a long and complex foreign body in his urethra.

A 40-year-old male presented with a partially inserted tongue cleaner in his urethra with one end projecting from the urethral meatus and with a history of bleeding and pain. After a gentle attempt of removal using local anaesthetic gel the patient was scheduled for its surgical removal under anaesthesia.

Large complex foreign bodies may be not amenable to endoscopic removal and may warrant open surgical procedure. Urethral stricture should be suspected in such patients. A psychiatric visit should be recommended for all adult males with self-inflicted foreign body in the urethra.

Read more at: http://ht.ly/RxoY1 HT https://twitter.com/NCBI

Unusual Foreign Bodies in the Urinary Bladder and Urethra Due to Autoerotism

Below:  A green colored tube projecting from the external meatus

Below:  Abnormal extravasation of contrast in bulbous urethra was seen on retrograde urethrography (RGU)

Below:  (A) Two magnets were removed from urethral meatus with meatotomy. These two magnets are round shaped and 0.7 cm in diameter. (B) A rod-shaped material that was curved in 20 degrees, 10 cm long and 0.5 cm in diameter.

Below:  Abnormal calcifications (white arrow) were observed in urethral meatus and pelvic cavity on plain KUB film

Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Diagnosis of these foreign bodies can be done by clinical history, physical examination, and image studies of the patient. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended to prevent bladder and urethral injuries. In some cases, however, surgical treatment should be done if the foreign bodies cannot be removed by the endoscopic procedure or further injuries are expected as a result of the endoscopic procedures. Herein we present 2 cases of self-inserted lower genitourinary foreign bodies with a brief review of the literature.

Read more at:  http://ht.ly/R8RAK HT @NCBI 

Allen Key Completely in Male Urethra: A Case Report

Below:  X-ray of the pelvis showing the Allen key completely in the anterior urethra

Below:  X-ray of the pelvis showing the Allen key in the urethra

Below:  External urethrotomy of the anterior urethra showing the metallic object in the urethra

Below:  Allen key removed from urethra

Introduction

Various cases of self-inflicted foreign bodies in the male urethra have been reported. Most of them are associated with autoerotic stimulation, psychiatric disorders or intoxication.

Case presentation

We report the first case of a patient who put an Allen key completely in his urethra. The patient presented with dysuria, haematuria and penile pain.

Conclusion

A self-inflicted urethral foreign body is a rare situation. Endoscopic removal is the recommended first-line treatment and if unsuccessful, open procedures may be necessary.

Read more at:  http://ht.ly/R2XN9 MT @BioMedCentral 

Polyembolokoilamania: Self-Insertion of Transistor Radio Antenna in Male Urethra

Below:  Oblique pelvic X-ray showing foreign body in the region of penile and bulbar urethra

Below:  Intra-operative photograph of the foreign body being removed via external urethrotomy of the anterior urethra

Below:  Post-operative photograph of the foreign body - a transistor radio antenna. The antenna is an aluminium tube and measured 13 cm in length

Though self-insertion of a foreign body in the male urethra is an infrequent urologic emergency, a weird variety of self-inserted foreign bodies have been reported. Most of these are attributed to autoerotic stimulation, a consequence of mental illness or the result of drug intoxication. We report an unusual case of a 65-year-old African man who self-inserted a broken transistor radio antenna into his urethra to serve as an improvised ‘itchstick’ to ease a bothersome itchy urethral condition. The foreign body subsequently migrated proximally out of reach. He presented a week after with urethral bleeding following nocturnal penile erections and we describe his evaluation and the challenge of retrieval. The reasons for self-inserting objects into the urethra may be as varied as the foreign bodies themselves and may include objects being used as an improvised ‘itchstick’ for itchy urethral conditions. The urologist's creative tendencies will often be required in safely removing these objects.

Read more at:  http://ht.ly/R2U6P HT @NCBI