Foreign body in urethra is an object that enters the urethra as a result of injection for the purpose of sexual satisfaction, with some medical manipulations, in the case of mental disorders. The symptoms of the pathological condition are reduced to pain during urination and sexual arousal (in men), burning, with the development of the inflammatory process – an increase in temperature and the presence of purulent secretions. Diagnosis is carried out on the basis of the results of the survey and examination of the patient, X-ray and ultrasound examinations, urethrocystoscopy. Removal is performed with special tweezers, a resectoscope, through open surgical intervention.
Meaning
Foreign body in urethra is a relatively frequent reason for a visit to a specialist in the field of clinical urology. In most cases, such a problem is addressed by men, since the structure of their urethra is more predisposed to the delay of various injected objects. In women, the urethra is shorter and wider, so foreign bodies enter the bladder more easily or leave the canal when urinating. Men have a number of constrictions and extensions along the urethra, in which the object can linger and stay indefinitely for a long time – cases of a long-term course of such a condition are described. According to statistics, this phenomenon is more common in children, young men, as well as in elderly people with signs of senile dementia.
Causes
The predominant observation of this condition in children and young men is due to the fact that curiosity or sexual satisfaction (masturbation) becomes the reason for the introduction of foreign bodies through the opening of the urethra. The list of items used for this purpose is very wide – pencils, ballpoint pen rods, hairpins, thermometers, toothpicks. Sometimes, when masturbating, foreign things are introduced into the urethra by girls. In addition, in some cases, such actions of women are aimed at causing termination of pregnancy by mistakenly inserting an object not into the vagina, but into the urinary tract. Persons with mental disabilities or senile dementia can repeatedly perform actions of this kind.
In other cases, foreign bodies remain in the urethra as a result of certain medical procedures. These may be fragments of suppositories introduced for therapeutic purposes, parts of endoscopic equipment (tips and components of cystoscopes, resectoscopes), surgical instruments – gauze balls, segments of ligatures and drains. The latter often enter the canal in a descending way after operations on the kidneys, ureters or bladder. Very rarely, foreign bodies penetrate the urinary tract through their wall – as a result of surgical manipulations on the pelvic organs, due to penetrating wounds.
Pathogenesis
When a foreign body penetrates through the external opening of the urethra in men, it can easily slip into the navicular fossa and fix itself. Much less often, a deeper location of a foreign object is found – in the prostatic or posterior part of the urethra. In the case of a small size, smoothness of the surface and chemical indifference of the injected object, it can be in the urinary tract for a long time, only slightly complicating the outflow of urine and causing discomfort, especially with an erection. If the object has sharp edges or is capable of irritating the tissues of the mucous membrane, then this causes a number of complications and is manifested by a characteristic clinical picture.
In case of traumatization of the urethra, a foreign object causes the appearance of bloody discharge, blood clots. It is possible to develop acute ischuria – urinary retention. Injuries cause the growth of connective tissue, leading to scarring (stricture) of the urethra. Irritation of the mucous membrane provokes the development of inflammation (urethritis), which can be complicated by a secondary bacterial infection and take a purulent character. The prolonged (for months or years) presence of an extraneous body in the urine environment leads to its encrustation or fouling with salts – thus, an object that initially practically does not obstruct urodynamics can gradually partially or completely obstruct the urethra with the development of ischuria.
Symptoms
The peculiarity of the condition is the fact that the patient, with rare exceptions, knows about the presence of a foreign body in his urethra. On the one hand, it facilitates the diagnosis of pathology, but on the other hand, the patient may not go to the doctor or hide the symptoms because of shame and ethical reasons. Manifestations of the presence of a foreign object in the first time after its introduction are a feeling of discomfort, soreness, which may weaken over time, provided the small size and smoothness of the injected object. Discomfort and painful sensations are aggravated by urination or sexual arousal.
Large objects or bodies with uneven edges injure the urethral mucosa, causing its swelling and completely blocking the lumen. This situation leads to the development of symptoms of ischuria – strong urge to urinate, pain in the suprapubic region, anxiety of the patient up to a panic attack. Intensive traumatization provokes the appearance of bloody discharge and (while maintaining the pathways for urine outflow) macrohematuria. In the future, symptoms may be joined by signs of urethritis – burning, pain in the penis and perineum area, which increases during urination, an increase in body temperature, manifestations of general intoxication (headaches, nausea, depression).
With a descending path of penetration of a foreign body into the urethra due to surgical interventions, the symptoms may be erased against the background of the patient’s postoperative condition. Soreness, burning and other manifestations on the background of cystourethroscopy are sometimes explained by side effects after the procedure, so it is possible to determine the presence of the remaining fragments of the toolkit only after some time. The clinical picture of such foreign objects in the urinary system differs from the ascending penetration only by a lesser severity of symptoms and a predominant lesion of the posterior parts of the urethra.
Complications
The earliest and most pronounced complication of a foreign body in urethra is acute urinary retention (ischuria) caused by obstruction of the urinary tract by both an actual foreign object and concomitant mucosal edema. In especially severe cases, in the absence of medical care, ischuria can provoke bilateral hydronephrosis and acute renal failure. Among other common consequences are infectious complications (urethritis), penetration of an object into the bladder, strictures of the urethra. Urethral ruptures are extremely rare. In men, when the body is localized in the prostatic department, inflammation can pass to the prostate gland, provoking acute prostatitis.
Diagnostics
With the ascending path of the body entering the urethral lumen, diagnosis can be based only on the patient’s testimony, but not all of them are ready to sincerely tell about the existing problem. Therefore, in addition to questioning the patient, endoscopic, radiographic and ultrasound diagnostic methods are used to determine the presence of an extraneous object. In addition, the above-mentioned instrumental techniques allow you to accurately determine the localization and position of the object in the urethra, which is necessary to choose the method of its removal. The algorithm for diagnosing this condition usually looks like this:
- Questioning and anamnesis collection. The patient finds out exactly when the foreign object was introduced and what it is (to assess its size, shape and other characteristics). If there are manifestations of the presence of a third-party body in a patient who has undergone surgery on parts of the excretory system, a downward path of penetration is assumed. The examination consists in palpation of the penis – in the case of the location of the body in the anterior sections, its localization can be determined in this way.
- X-ray and ultrasound examination. Pelvic x-ray in this pathology is justified if the injected body is dense and delays X-rays well. With a reduced density (for example, a cotton ball, plastic, a fragment of a ligature), it is better to use ultrasound techniques – ultrasound of the urethra, bladder. Through these studies, the position, dimensions, and shape of the third-party object are clarified.
- Endoscopic techniques. Urethroscopy allows you to visually assess the position of the object and the condition of the surrounding tissues – injuries and swelling of the urethra. In some cases, these methods are used in combination with the removal procedure.
Differential diagnosis of a foreign object inside various parts of the urethra is performed with urethral strictures, its obturation with calculus in urolithiasis, some forms of urethritis. An important role is played by the correct behavior of the urologist with the patient, his ability to position the patient to maximum sincerity in order to obtain truthful anamnesis data. This significantly speeds up the diagnosis and facilitates the choice of treatment method.
Treatment
Treatment consists in removing the external body from the lumen of the urinary tract by one method or another. The choice of a specific technique depends on many factors – the prescription of the introduction of the object, its location, size, shape, nature of the surface. Small size and smoothness are not always a positive point in terms of extraction – it is difficult to capture such an object with a tool in the narrow lumen of the urethra. For this reason, there should always be an individual approach to the treatment of pathology, based on the maximum amount of diagnostic data. There are several groups of methods aimed at removing third-party things from the urethra:
- Conservative approach. With small and recently introduced objects, not complicated by swelling or traumatization of the mucosa, it is possible to eliminate the body with a urine flow. To do this, the patient is asked to wait for strong urges to urinate and at the moment of this process, pinch the opening of the urethra with his fingers (to increase pressure and fill the channel with fluid), and then abruptly release. Acceleration of the urine flow can take the object out of the lumen of the channel.
- Transurethral removal. Extraction is performed by grabbing the body with a resectoscope or a multifunctional cystoscope and pulling it out. In the case of large-sized items in the urethral tube, it is recommended to pre-enter the patient into anesthesia to reduce the pain of the procedure, relax the pelvic muscles.
- Surgical removal. It is used in the presence of objects complicated by urethritis, salt encrustation or injuries of the urethra, there are only two approaches to surgical treatment. The first is to push the object into the bladder cavity, from where it will be extracted by open or endoscopic suprapubic cystotomy. The second approach is more traumatic for the genitourinary system and boils down to gaining access to the affected part of the urethra with its further opening, removal of the body and stitching of the canal walls.
According to the indications, urethritis is treated with anti-inflammatory and antibacterial drugs, they are also recommended to be used when prostatitis is attached. In case of severe traumatization of the inner surface of the urethra after extraction, catheterization of the patient for 7-12 days is recommended to prevent the development of strictures and scarring. It also helps to reduce discomfort in the recovery or postoperative period.
Prognosis and prevention
The prognosis in the presence of a foreign body in urethra is favorable, with timely access to a doctor and removal of the object, the functionality of the genitourinary system is fully restored. The recovery time depends on the method of removal – with conservative and transurethral approaches, it is minimal, with surgical intervention it may take 2-3 weeks. Prevention of the condition consists in avoiding the introduction of foreign objects into the urinary tract cavity, monitoring mentally unstable persons or people with senile dementia. If there are pathologies of the excretory system, before using tips related to the introduction of various medicines or other objects into the urethra, you need to get a recommendation from a qualified urologist.