Self-inflicted long complex urethro-vesical foreign body: is open surgery always needed?

Area of Science:

• Urology
• Minimally Invasive Surgery
• Case Report

Background:

• Self-inflicted foreign bodies in the urinary tract present unique management challenges.
• Complex urethrovesical foreign bodies, such as long electric cables, can lead to severe voiding dysfunction and hematuria.
• Previous management often involved open surgical exploration.

Observation:

• A 21-year-old male with a history of antipsychotic treatment presented with a long electric cable wire extending from the penile urethra into the bladder.
• Initial cystoscopic attempts at foreign body retrieval failed due to a complex knot within the bladder.
• The patient experienced significant voiding difficulty and gross hematuria.

Findings:

• A percutaneous minimally invasive approach was successfully employed to manage the complex urethrovesical foreign body.
• Suprapubic puncture, guide-wire placement, and serial dilation facilitated access to the bladder.
• A nephroscope was utilized through the suprapubic tract for antegrade retrieval of the cable wire, preserving bladder and urethral integrity.

Implications:

• Minimally invasive techniques can be effective for managing complex self-inflicted urethrovesical foreign bodies.
• This approach offers a less traumatic alternative to open surgery.
• Successful retrieval highlights the adaptability of endoscopic tools in challenging urological scenarios.