Self‐inflicted male urethral foreign body insertion: endoscopic management and complications

Abstract

OBJECTIVE To evaluate the cause, diagnosis, management and complications of self‐inserted urethral foreign bodies in men, reviewing a 17‐year experience. PATIENTS AND METHODS From November 1986 to January 2004, 17 men were treated for self‐inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications. RESULTS In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton‐tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body. CONCLUSION Self‐inflicted urethral foreign‐body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow‐up, albeit difficult in these patients, is desirable.

Unusual foreign body in the vesico-urethral; 195 cm liquid pipe

“…[5,6] The presenting symptoms of these patients include urinary retention, dysuria, painful erection, microscopic or even macroscopic hematuria, and as is in our case, it can be incontinence secondary to incomplete closure of urethral sphincter. [7] In their series of 17 cases, Rahman et al [8] indicated psychiatric disorders, and auto-erotic drives as causes of self-insertion of foreign substances. In addition, Trehan et al [9] reported a patient without any psychiatric disorder, but experienced post-MI erectile dysfunction, and inserted telephone cables for erection, and sexual satisfaction.…”

Unusual Foreign Bodies in the Lower Genitourinary Tract

“…2,3 Self-infliction is more common in men than the women with a ratio of 7:1. 4 Motivation for self-infliction is mostly auto-erotic. Other reasons are psychiatric disorders, mental confusion, narcotic drug intoxication etc.…”

An unusual case of polyembolokoilamania: Urethral avulsion from foreign object use during sexual gratification

“…Complications may include mucosal tears, false passages, stenosis, infection, abscess, pain, erectile dysfunction, fistula formation, and further lower urinary tract symptoms. [1][2][3]5,8 After the acute urological problem is managed, the motive and underlying etiology should also be considered. Medical and psychosocial issues often exist, which require further assessment.…”