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      Multiple lower urinary tract calculi induced by foreign bodies insertion: A case report

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          Abstract

          Lower urinary tract foreign bodies are often reported but the underlying causes remain intriguing, ranging from unconventional practices to medical interventions. This condition predominantly affects young males and presentations are varied from asymptomatic, lower urinary tract symptoms to acute obstructive renal failure. We report a case of a 48-year-old male presented with lower urinary tract symptoms and obstructive renal failure. Imaging revealed multiple foreign bodies in the pelvic cavity, suggestive of vesical, and urethral lithiasis. Urethrocystoscopy removed an 8-cm needle with rubber band and a 10-cm encrusted cable, forming a urethral stone. Vesicolithotomy removed a 5 × 3 cm bladder stone with a SIM card inserter as its core. The patient's condition improved after surgery. Notably, the patient's history prompted a psychiatric evaluation, leading to the diagnosis of and treatment for an adjustment disorder. While endourology procedure is effective in most cases, some cases necessitate open surgery. Identification and treatment of underlying psychiatric disorders is needed to for long term care.

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          Most cited references16

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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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            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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              CLINICAL MANAGEMENT OF FOREIGN BODIES OF THE GENITOURINARY TRACT

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                Author and article information

                Contributors
                Journal
                Radiol Case Rep
                Radiol Case Rep
                Radiology Case Reports
                Elsevier
                1930-0433
                28 March 2024
                June 2024
                28 March 2024
                : 19
                : 6
                : 2443-2447
                Affiliations
                [a ]Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
                [b ]Department of Urology, Abdoel Wahab Sjahranie Hospital, Samarinda, East Kalimantan, Indonesia
                [c ]Department of Urology, Faculty of Medicine, Universitas Airlangga, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
                Author notes
                [* ]Corresponding author. yodisoebadi@ 123456gmail.com
                Article
                S1930-0433(24)00189-4
                10.1016/j.radcr.2024.02.100
                10997869
                38585402
                d76719e3-53cb-488f-950c-6811c2454097
                © 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 30 November 2023
                : 24 February 2024
                : 27 February 2024
                Categories
                Case Report

                lower urinary tract,foreign body,obstructive nephropathy,endoscopy,psychiatric disorder

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