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      A Self Inserted Unusual Foreign Body “An Entire Pencil” in a Male Urethra and Bladder: A Case Report

      case-report
      1 , , 2 , 3
      ,
      Cureus
      Cureus
      rare foreign body, emergency, intact pencil, urinary bladder, urethra

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          Abstract

          The incidence of lower urinary tract foreign body insertions is low. The motives for the insertion of objects are complex to comprehend and could be a result of exotic impulses, psychometric problems, or sexual curiosity. Here we discuss a case of a 21-year-old male who came to the emergency room with complaints of a painful protrusion from the perineum and a history of insertion of an unusual foreign body in the form of an approximately 15cm long pencil that was inserted out of sexual curiosity to achieve autoerotism which was impacted in the posterior urethra and the bladder. Diagnosis in such cases can be achieved by proper history taking, conducting a thorough physical examination, and with use of appropriate imaging. The treatment options vary between minimally invasive procedures such as endoscopic removal and surgical treatment, with the former being used more often and the latter being done when the minimally invasive procedures are not able to remove the foreign body or when urethral or bladder injuries are expected in doing so. The complete case is discussed in detail to derive the proper management strategy in such rare cases.

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          Self-inflicted male urethral foreign body insertion: endoscopic management and complications.

          To evaluate the cause, diagnosis, management and complications of self-inserted urethral foreign bodies in men, reviewing a 17-year experience. From November 1986 to January 2004, 17 men were treated for self-inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications. In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton-tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body. Self-inflicted urethral foreign-body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow-up, albeit difficult in these patients, is desirable.
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            Clinical management of foreign bodies of the genitourinary tract.

            The variety of foreign bodies inserted into or externally attached to the genitourinary tract defies imagination and includes all types of objects. The frequency of such cases renders these objects an important addition to the diseases of the urinary organs. We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized. Our review encompassed approximately 800 single case reports on foreign bodies in the English world literature published between 1755 and 1999. We structured the range of introduced objects, by referring to origin and material as well as the genitourinary organs involved. Furthermore, we noted symptomatology and diagnoses, including psychological involvement, as well as possible treatment options. The most common motive associated with foreign bodies of the genitourinary tract is sexual or erotic in nature. The most suitable method of removing a urethral foreign body depends on the size and mobility of the object applied to the genitourinary tract. When possible, endoscopic and minimal invasive techniques of removal should be used. However, surgical retrieval of a foreign body may be required, particularly when there is a severe associated inflammatory reaction.
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              Unusual foreign bodies in the urinary bladder and urethra due to autoerotism.

              Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Diagnosis of these foreign bodies can be done by clinical history, physical examination, and image studies of the patient. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended to prevent bladder and urethral injuries. In some cases, however, surgical treatment should be done if the foreign bodies cannot be removed by the endoscopic procedure or further injuries are expected as a result of the endoscopic procedures. Herein we present 2 cases of self-inserted lower genitourinary foreign bodies with a brief review of the literature.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                22 May 2022
                May 2022
                : 14
                : 5
                : e25198
                Affiliations
                [1 ] General Surgery, Shyam Shah Medical College, Rewa, IND
                [2 ] Pediatrics, Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, IND
                [3 ] Urology, Super Speciality Hospital Rewa, Rewa, IND
                Author notes
                Article
                10.7759/cureus.25198
                9215648
                574cc8ec-3462-4633-a492-e993685de970
                Copyright © 2022, Ahmed et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 May 2022
                Categories
                Urology

                rare foreign body,emergency,intact pencil,urinary bladder,urethra

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