An Unusual Foreign Body in the Bladder and Percutaneous

Removal

YOUNESI M1, AHMADNIA H2, ASL ZARE M2

1- Department of Uorology, Mazandaran University of Medical Sciences, Mazandaran, Iran

2- Department of Uorology, Mashhad University of Medical Sciences, Mashhad, Iran

KEY WORDS: bladder, foreign body, endoscopy, percutaneous

53

Urology Journal

UNRC/IUA

Vol. 2, 53-54 Spring 2004

Printed in IRAN

Introduction

Foreign bodies in the bladder have been com-

monly reported. However, we describe a rare for-

eign body which was a carpule containing lido-

caine that was removed percutaneously.

Case Report

A 28-year male, married patient was referred to

this center with irritative urinary symptoms (fre-

quency, nocturia, and dysuria) initiated a week

before. In his history, he mentioned the existence

of an ampule in his body and masturbation for

seven years. Psychological disorder or drug abuse

was not reported. Physical examination was nor-

mal except for a mild tenderness in the suprapu-

bic area. A foreign body was observed in pelvic

anteroposterior radiography (fig. 1). Cystoscopy

under local anesthesia was performed and a lido-

caine carpule was detected. Removal throughout

urethra was not viable as it was fragile. Thus, we

considered percutaneous extraction as the treat-

ment of choice. Open surgery could be an alterna-

tive approach.(1,2) Laparoscopic technique has

recently been reported as well.(3)

The patient was secured in the supine position.

Under general anesthesia a 18 F foley catheter

was inserted, the bladder was filled up to its nor-

mal capacity with normal saline, and the skin was

incised 1 cm long in the suprapubic area, 1.5 cm

over the symphysis pubis using scalpel. We

entered the bladder with a puncture needle and

placed a 0.035 inches J type guide wire as soon as

we confirmed that the needle was within the blad-

der. Tract dilatation up to 30 F was done by a tel-

escopic dilatator and finally a 30 F Amplatz sheet

was placed. Cystoscopy was performed using a

Wolf 25° nephroscope and a dentistry type lido-

caine carpule was seen. It was successfully

removed with a grasp (fig. 2,3). Eventually, the

skin was sutured with a 2.0 nylon and a 18 F foley

catheter was placed for three days. Tree-month fol-

low-up showed complete improvement and no com-

plication.

Accepted for publication in August 2003

FIG. 1. anteroposterior radiography demonstrates

Lidocaine carpule

FIG. 2. The nephroscope, grasp, and Amplatz sheet

used in this case



AN UNUSUAL FOREIGN BODY IN THE BLADDER AND PERCUTANEOUS REMOVAL

Discussion

Bladder is the most susceptible part of the gen-

itourinary system for foreign bodies. Usually for-

eign bodies are pushed to the urethra while trying

to eliminate them or involuntary perineal muscle

contraction that makes them enter the bladder. In

men, they should be passed through a 20-25 cm

pathway to reach the bladder. Surprisingly, the

urethral curve remains intact and there is no per-

suading explanation for this event.(4)

Almost everything surrounding the human has

been reported as bladder foreign body such as

nasal mucosa, hair, pieces of broom-straw, per-

fume bottle, pearl shaped bottoms, wires, beans,

cables, sutures, clips, and toothbrush.(5) According

to their main characteristics and origin, foreign

bodies are classified as: 1. Particles from animal

bodies or insects: dog penis, ant, snake, tail verte-

bra, etc., 2. Plants and vegetables: grass, wood

stick, elm used for abortion, etc., 3. Liquefiable

materials: wax, chewing gum, glue, etc. However,

some foreign bodies can't be included in this clas-

sification.

In some cases they may enter to the bladder

unintentionally such as hair while catheteriza-

tion.(6) A common one is thermometer that slips

into the bladder in females.(7) In exceptional cases,

foreign bodies has been pushed into the bladder in

sexual harassments.(8) Trauma, particularly gun-

shot is another causal factor. In addition, iatro-

genic entrance and migration of foreign bodies

from adjacent organs have been described as the

mechanism.(5,9)

Percutaneous approach to remove foreign bodies

is a safe and effective method and is of great help

in the cases in which removal is not possible

through the urethra. We successfully used this

method considering the limitations of our case.

Percutaneous approach is also an ideal alternative

to open surgical operation.

References

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3. Ejstund P, Roulsen J. Laparoscopic removal of an electric

wire from the bladder. BJU 1997; 30: 338.

4. Aliabadi H, Cass AS, Gleich P, et al. Self-inflicted foreign

bodies involving lower urinary tract and male genitals.

Urology 1985; 26: 12.

5. Abdulla MM. Foreign body in the bladder. BJU 1990;

65:420.

6. Zeitlin AB, Cottrell TL, Lloyd FA. Hair as a lower urinary

tract foreign body. J Urol 1957; 77: 840.

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Aeta Urol Belg 1982; 50:331.

54

FIG. 3. Lidocaine carpule extracted from the

bladder