Endourological Treatment of Foreign Bodies in the Urinary System

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Abstract

Background and Objectives:

In this retrospective study, nature, clinical presentations, diagnostic modalities, and endoscopic treatment of urinary system foreign bodies were evaluated.

Methods:

A total of 8 cases were treated with endoscopic surgery between February 15, 2007 and June 12, 2012. Clinical findings, radiologic diagnosis, and management were reviewed.

Results:

We observed that urinary tract foreign bodies were generally secondary to iatrogenic causes; however, bladder/urethral foreign bodies could also be due to self-insertion. Clinical findings were different secondary to their location in the urinary system. All foreign bodies were treated endoscopically.

Conclusions:

Foreign bodies of the urinary system can successfully be treated with endoscopic modalities without any complications.

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Most cited references 21

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Clinical management of foreign bodies of the genitourinary tract.

A van Ophoven, J B deKernion (2000)

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

Inayat U Rahman, P Elliott, Jack McAninch (2004)

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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Retained foreign bodies after surgery.

Kent W Kercher, B. Todd Heniford, Robert Harrell … (2007)

Medical errors during surgery are not well studied. To define risk factors associated with this type of error, we performed a case control analysis. We retrospectively reviewed medical records involving the ICD-9 code (998.4) for unintentional foreign object remaining in the body during surgery and incident reports gathered by the Department of Risk Management over a 10 year period from 1996 to 2005. Thirty cases were matched with at least four randomly selected controls (131 control patients) that underwent the same type of operation during the same time period. Thirty patients had retained foreign objects (52% sponges and 43% instruments). The abdominal cavity was most commonly involved (46%) followed by the thoracic cavity (23%) although no body cavity remained uninvolved. Eight patients required readmission (30%), 25 patients required reoperation (83%), and there was no mortality. When compared with controls, patients with retained foreign objects were more likely to have had a greater number of major surgical procedures at the same time (2.7 versus 1.8, P=0.004), to have multiple surgical teams (13% versus 2%, P=0.02), and more likely to have had an incorrect instrument/sponge count recorded (13% versus 2%, P=0.01). In multivariate analysis, factors associated with a significantly higher risk of retained foreign objects were the total number of major procedures performed [odds ratio 1.6; 95% confidence interval (CI), 1.1-2.3; P=0.008] and an incorrect count (odds ratio 16.2; 95% CI, 1.3-197.8; P=0.02). Retained foreign objects after surgery are associated with multiple major surgical procedures being performed at the same time and an incorrect instrument or sponge count. Identification of these risk factors using case-control analysis should influence operating room policy and reduce these types of errors.

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Author and article information

Contributors

Erdal Alkan

M. Murad Basar

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Jul-Sep 2014

Volume: 18

Issue: 3

Electronic Location Identifier: e2014.00271

Affiliations

Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey.

Author notes

Address correspondence to: Erdal Alkan, MD, Memorial Sisli Hospital, Department of Urology, Okmeydanı 34385 Sisli-İstanbul, Telephone: +90.212.314 66 66, Fax: +90.212.314 66 08, E-mail: eralkan@ 123456hotmail.com

Article

Publisher ID: JSLS-D-13-00271

DOI: 10.4293/JSLS.2014.00271

PMC ID: 4154419

SO-VID: 2ecfc55f-a878-4f67-9323-b027e27ef51e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Endourological Treatment of Foreign Bodies in the Urinary System

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Abstract

Background and Objectives:

Methods:

Results:

Conclusions:

Related collections

Karger: Gastroenterology

Most cited references 21

Clinical management of foreign bodies of the genitourinary tract.

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

Retained foreign bodies after surgery.

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