11 year old Sohom* came to the Paediatric Urology OPD in Fortis Hospital and Kidney Institute, complaining of pain during urination and blood stained urine since 3 weeks. Sohom, a shy boy from a remote village of Burdwan, had undergone treatment from a local physician with antibiotics for a presumed urinary tract infection, but there was no significant improvement. The child denied any history of trauma or assault. He neither had any history of viral fever, nor any bleeding tendency in the past. On local examination he had lower abdominal tenderness. Ultrasound revealed a tube like structure within the urinary bladder. X-ray confirmed a large coiled tube within the urinary bladder extending into the penis. Although the child denied initially, but on counseling he said that he had inserted a plastic tube within his urinary passage. The initial tube got displaced within the bladder. To retrieve it he introduced a second tube, which also got lost within the penile opening. He couldn’t disclose these incidents to his parents out of embarrassment. Dr Pushkar Shyam Chowdhury, Consultant, Urologist, decided to do a cystoscopic evaluation and possible retrieval of the tubes. If endoscopic attempt failed, the child would need his bladder to be cut open for retrieval of the foreign body. Cystoscopy revealed a black electric wire around 5 cm long within the urethra. This was retrieved endoscopically. But there was another white electric wire, around 35 cm long within the bladder which got twisted and knotted. Retrieving it through the narrow urethra was the biggest challenge. This wire was untwisted and unknotted endoscopically and retrieved in toto without causing any further injury to the natural passage. The child was kept on catheter for one week for the internal injuries to heal. The child was healthy after catheter removal and could pass urine normally. Finally, psychiatric consultation was done to prevent further attempts at insertion of other foreign bodies in the natural orifices.
Most foreign bodies in the lower genitourinary tract are self-inserted via the urethras as a result of exotic impulses, psychometric problems, sexual curiosity or sexual practice while intoxicated. Foreign bodies in the lower urinary tract can be removed and cured with immediate diagnosis and proper management. However, if foreign bodies remain persistently, complications such as infection, stones, fistula formation and sepsis leading to even death may occur. Foreign body removal should always be attempted endoscopically. However in case of large foreign bodies, those impacted in the wall or difficult situations like this case may warrant open surgeries.
*name changed, to protect privacy.