Foreign Bodies in the Urinary Bladder and Their Management: A Single-Centre Experience From North India

Abstract

Purpose: This study was performed to characterise the nature, clinical presentation, mode of insertion, and management of intravesical foreign bodies in patients treated at our hospital.

Methods: Between January 2008 and December 2014, 49 patients were treated for intravesical foreign bodies at King George Medical University, Lucknow. All records of these patients were retrospectively analysed to characterise the nature of the foreign body, each patient's clinical presentation, the mode of insertion, and how the case was managed.

Results: A total of 49 foreign bodies were retrieved from patients' urinary bladders during the study period. The patients ranged in age from 11 to 68 years. Thirty-three patients presented with complaints of haematuria (67.3%), 29 complained of frequency of urination and dysuria (59.1%), and 5 patients reported pelvic pain (10.2%). The circumstances of insertion were iatrogenic in 20 cases (40.8%), self-insertion in 17 cases (34.6%), sexual abuse in 4 cases (8.1%), migration from another organ in 4 cases (8.1%), and assault in 4 cases (8.1%). Of the foreign bodies, 33 (67.3%) were retrieved by cystoscopy, while transurethral cystolitholapaxy was required in 10 patients (20.4%), percutaneous suprapubic cystolitholapaxy was performed in 4 patients (8.1%), and holmium laser lithotripsy was performed in 2 patients (4.08%).

Conclusions: Foreign bodies should always be included in the differential diagnosis when evaluating a patient who presents with chronic lower urinary tract symptoms. A large percentage of foreign bodies can be retrieved using endoscopic techniques. Open surgical removal may be performed in cases where endoscopic techniques are unsuitable or have failed.

Keywords: Endoscopy; Foreign Bodies; Iatrogenic Disease; Urinary Bladder.

Fig. 1.

Pelvic (A, B) and kidney-ureter-bladder (C) X-rays showing a forgotten JJ stent with encrustation and stone formation.

Fig. 2.

(A) Coronal reformatted noncontrast computed tomography image showing intrauterine contraceptive device in the bladder. (B) Three-dimensional reconstructed computed tomography image showing the same device as in panel A.

Fig. 3.

An X-ray of the pelvis (A) and computed tomography (axial section) (B, C) showing a bullet in the urinary bladder (marked with a red arrow).

Fig. 4.

Percutaneous cystolitholapaxy technique. (A) Under transurethral 19-Fr cystoscopic guidance, a suprapubic tract was made with telescopic metal dilators (Alken dilators) (yellow arrow), and a 24-Fr Amplatz sheath was placed (blue arrow). (B) The bullet was visualised with a 22-Fr nephroscope through the percutaneous tract. (C) The bullet was retrieved using stone-grasping forceps (red arrow). (D) The bullet after removal.

Fig. 5.

(A) Axial computed tomography (CT) image showing a pen in the urinary bladder reaching up into the anterior abdominal wall. (B) Axial CT image showing the same pen piercing the left posterior bladder wall.

Fig. 6.

Computed tomography scan (coronal section) showing a plastic box in the bladder.

Fig. 7.

(A–C) Retrograde urethrogram revealing a short-segment bulbar urethral stricture (red arrow).