Due to its high frequency, the subject of urogenital tracts foreign bodies has been of interest to urologists; therefore, urologists must be aware of how to treat patients with foreign bodies (1). Following prior studies, a variety of objects as a foreign body of urogenital tracts, which can be inserted into these tracts or attached to them, has been reported (2,3). The leading cause behind inserting objects into urogenital tracts is sexual desire (3). It mainly occurs when adults often suffer from mental health disorders and try to masturbate with objects. Herein, we describe a case that inserted the whole of a phone cable into his bladder through the urethra (4).
A 19-year-old boy was referred to our hospital with complaints of dysuria, nocturia, and suprapubic pain for approximately three weeks. He agreed to report his case by signing the informed consent, and the case report is based on case reporting (CARE) guidelines. He has been under treatment with a diagnosis of multiple sclerosis for almost two years. He also mentioned that these symptoms had worsened in the last two weeks. Tenderness in the supra-pubic region was the only sign detected in clinical examination. In addition to pus, red blood cells were detected in urine analysis, and the urine culture result was negative. An abdominal X-ray was performed for the patient, and a cable was seen in the imaging (Figure1). The patient was admitted and taken to the operating room. Under general anesthesia, the cystoscopy was performed using grasper, and the cable was removed from the patient's bladder. He was discharged a day after with just a few irritative symptoms. At discharge, the patient’s parents were advised to get the case for psychiatric consultation.
Figure 1. Abdominal X-ray
Dealing with foreign bodies of urogenital tracts has been challenging for urologists, and urologists’ experiences showed that most cases require interventions. Regarding choosing the best method of removing foreign bodies, the primary factors that should be focused on are the size and mobility of the object (1,5). In addition, the type of foreign body and foreign body location plays a pivotal role in choosing the best intervention method. The methods applied so far include meatotomy, cystoscopy, internal urethrotomy, external urethrotomy, suprapubic cystotomy, Fogarty catheterization, and solvent injection. Evidence supports the endoscopic method as the gold standard of object removal (1), especially in cases with foreign bodies above the urogenital diaphragm (6).
Patients with foreign bodies in urogenital tracts usually present with symptoms such as dysuria, nocturia, hematuria, urinary frequency, partial or complete urinary retention, and difficult voiding (7). The initiation of symptoms after foreign body insertion varies from several hours to several months (8,9), and oddly, this time for an Egyptian man was about seven years following Abdulla's report (10). Unfortunately, a significant proportion of patients with urogenital foreign bodies do not come to hospitals other than they become symptomatic (6). Foreign bodies may result in severe complications, including urethritis, hemorrhage, urethral diverticula, periurethral abscess, and periurethral fistula, and owing to these, immediate treatment necessitates (11) Apart from surgical interventions, because of underlying mental disorders in the majority of cases, psychiatric assessments should be performed for patients (12).
Clinical history, along with radiologic examination, is the primary tool for the diagnosis of urogenital tracts foreign bodies. Radio-opaque objects can be readily diagnosed with pelvic X-ray, but if the object is radiolucent, the better radiological diagnostic method is retrograde cystography. The obvious benefit of ultra-sonography in objects of urogenital tracts is clarifying the precise location of objects (13,14). In our case, the phone cable was easily seen on a plain abdominal X-ray, and further imaging was not essential.
Foreign bodies can reach the urinary bladder in three ways: 1. accidentally, 2. Intentionally insert into the urethra 3. Migration from adjacent organs (15). When a patient inserts a cable into his/her bladder, at first, part of the cable remains in the urethra. However, the urethral part gradually moves into the bladder, which occurs during micturition, until the whole part of the cable is in the bladder (12).
A man with a history of inserting a telephone wire into his urethra was described. He presented with urethral bleeding, pain in the urethra, and suprapubic. He did that because of erectile dysfunction following a myocardial infarction, which happened 4 years before the heart attack (5). The manifestation of our case was similar to the mentioned case, but, in our case, the patient unintentionally inserted a phone cable into his bladder in contrast to the above case.
In the present study, we highlighted the importance of considering the foreign body of the bladder in patients with a mental health disorder. To diagnose the foreign body of the urogenital system, a pelvic radiograph plays a crucial role in diagnosing the disease. Moreover, the foreign body should be removed with surgical intervention.
All authors had an equal contribution.
Special thanks to the Urology Research Center (URC), Tehran University of Medical Sciences (TUMS).
Conflict of interest
All authors declare that there is not any kind of conflict of interest.
There is no funding.
All authors ensured our manuscript reporting adheres to CARE guidelines for reporting case reports. The patient agreed to report the case by signing the informed consent.
Data will be provided by the corresponding author upon request.
CARE Case reporting