Inadvertent urethral insertion of a contraceptive suppository

Abstract

We report the third case of a vaginal contraceptive suppository that was inserted accidentally per urethral causing severe chemical cystitis.

PIP: A case is reported of intravesical placement of a vaginal contraceptive suppository. 2 previously reported cases involving the same brand of suppository and treatment recommendations are reviewed. A 29-year-old woman inserted a contraceptive suppository 15 minutes prior to intercourse. Subsequently, she noticed transient, poorly localized burning that had not been present before she used the suppository. The woman had no history of urinary tract infection or similar symptoms. She awakened 4 hours later with intense urethral pain and inability to void. Catheterization was performed 1 hour later, yielding grossly bloody urine, following which she was able to urinate. Pelvic examination was normal, and an x-ray was negative for a foreign body. The patient complained of severe urgency, frequency, and terminal dysuria 3 days later at follow-up. Physical examination revealed a normally placed urethral meatus calibrated at 21 degrees Fahrenheit. Cystoscopic findings were remarkable for a pale, edematous trigone that stood in sharp contrast to an erythematous pancystitis in the remaining bladder mucosa. No foreign body was present. Capacity was 100 cc, above which marked pain was experienced. The urethral mucosa was inflamed. The patient was treated with trimethoprim-sulfamethoxazole and 50 mg prednisone orally, which was tapered to 10 mg/day. The symptoms persisted 6 days after the mishap with urinary frequency every 30 minutes. Urine culture was sterile. The patient was given 50 mg methylprednisolone sodium succinate in 50 cc sterile water intravesically for 1 hour along with antispasmodics. The patient was asymptomatic by day 14. The clinical findings resemble previously reported cases. The patient had no similar symptoms before or since this episode. Since the urine culture was sterile, and the patient was not taking antibiotics, there was no apparent reason for the severe cystitis. It is strongly believed that urethral insertion of the suppository was the etiology of the symptoms.