Foreign body in bladder is a foreign object that has entered the bladder cavity retrograde, descending or through damaged walls. There may be pain in the lower abdomen, dysuria, hematuria, pyuria; sometimes alkaline cystitis, pyelonephritis, urolithiasis develops, fistula formation is observed. The diagnosis is confirmed by ultrasound examination of the bladder, examination cystoscopy and radiopaque cystography. The foreign body is removed by transurethral endoscopy or by open surgical intervention.
Meaning
Foreign body in bladder is a problem that specialists in the field of practical urology often have to face. Household items (thermometers, pencils and fountain pens, plastic and metal tubes, hairpins), medical supplies (tampons, catheters and drains, suture material), shells (bullets, grenade fragments), osteomyelitis sequesters are found as foreign bodies. A foreign object often enters the bladder from the bottom up, i.e. through the urethra (retrograde), less often – from the surrounding tissues and when the bladder is injured, quite rarely – from the kidneys and urinary tract.
Causes
A foreign body can enter the bladder for various reasons. This can happen due to the efforts of the patient himself: as a result of childish pranks, masturbation or mental abnormalities of the patient. Foreign objects in the bladder cavity are detected in more cases in women; this is due to the fact that the female urethra is shorter and wider.
Iatrogenic ingestion of foreign bodies is caused by unsuccessful instrumental examinations and operations on the bladder and urethra, the use of faulty endoscopic devices, drains, catheters, and the abandonment of medical material. Sometimes a foreign object in the bladder can be detected due to gunshot and penetrating wounds of the abdomen. In rare cases, foreign bodies migrate into the bladder from the abdominal cavity and neighboring organs (when opening a purulent-necrotic focus, moving small objects through the ureter from the kidney, urogenital fistula, etc.).
Symptoms
The development of clinical symptoms is determined by the size and shape of the foreign body in bladder, its chemical composition and duration of stay in the organ cavity. Uninfected, chemically and biologically inert foreign bodies cause a weak inflammatory reaction of tissues and are practically not encapsulated. With a moderate immune response of the body, foreign objects are gradually covered with a fibrous capsule and have a long asymptomatic course.
With biologically foreign objects, an allergic tissue reaction may develop; with chemically active ones, necrosis of the surrounding tissues, and with poisonous ones, general intoxication. Symptoms of a foreign body can be pain in the lower abdomen, which increases with movement, urination disorders (painful frequent or intermittent, often – ischuria), hematuria (total or terminal), pyuria.
Complications
With inflammatory changes in the bladder, the phenomena of alkaline cystitis develop. Prolonged stay of a foreign body in the bladder contributes to the development of the inflammatory process and can be complicated by pyelonephritis. Over time, salts are deposited on a foreign object and stones are formed with the formation of bedsores, urinary congestion, vesico-vaginal fistulas.
Diagnostics
The clinical picture in combination with the anamnesis data may cause suspicion of the presence of a foreign body in bladder. The diagnosis can be confirmed by ultrasound of the bladder, cystoscopy, cystography (pneumocystography). In some cases, in women, a foreign object can be detected by vaginal examination (palpation of the bladder through the vagina).
Ultrasound of the bladder determines the presence of additional inclusions and signs of inflammatory changes. Cystoscopy helps to establish the presence of a foreign body, with the exception of objects that have been inlaid with salts for a long time, giving a picture of ordinary bladder stones (“pop-up concretions”).
Bladder x-ray (cystography) gives an image of a foreign body, reveals the secondary nature of urinary stones and the resulting defect in the filling of the bladder. With the X-ray negativity of a foreign body (a piece of gauze, suture material, etc.), it is detected in the bladder only after encrusting with salts or during pneumocystography.
Treatment
With a small size and smooth surface, a foreign body can be independently removed from the bladder during urination, otherwise hospitalization to the urological or surgical department is mandatory for its extraction. In case of severe pain, the pain syndrome is stopped with promedol or pantopone as an emergency, and when the temperature rises, antibacterial therapy is prescribed.
In most cases, a foreign body is removed from the bladder endoscopically through the urethra; when it is encrusted with salts, the stone is first crushed, and then the object itself is removed. The exception is foreign objects of large size, irregular shape, with sharp ends, for the removal of which a high cross-section of the bladder is performed (open epicystostomy).
In the postoperative period, drainage of the bladder is performed: in young women and men, after deaf suturing of the organ wall, with a permanent urethral catheter; in elderly patients and with pronounced inflammatory necrotic changes, a temporary suprapubic cystostomy is left. The prognosis after the extraction of a foreign body is favorable.