Mesanede nadir görülen bir yabancı cisim: kalem parçası

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Introduction
In females, foreign bodies of the urinary bladder are due
to self-insertion, iatrogenic causes or migration from
neighboring organs. In young females erotic stimulation
and in small children curiosity might result in having a
foreign body in the bladder. In addition, psychiatric disturbances, dementia or alcohol ingestion might lead to
uncontrollable behavior resulting in foreign bodies (1).
Iatrogenic foreign bodies do appear during endoscopic
interventions or stenting procedures. Foreign bodies due
to migration usually originate from neighboring organs
and are mainly the intrauterine devices (2).
In the present case we present the pen used for erotic
stimulation, which entered the bladder through the urethra. It is of interest as there is no such case in the literature.
Case Report
An 19-year-old single female patient admitted to the
hospital with the complaints of severe urinary infection
and bleeding. Direct urinary system X-ray demonstrated a
foreign body resembling a pen situated in the bladder
region. When the patient was questioned, she declared that
an uncontrollable behavior resulted in the piece of pen entering the bladder during erotic stimulation informing also
that her family was not yet aware of the situation (Figure
1). Cystoscopic examination showed a piece of pen with
hardened outer surface in the bladder (Figure 2). Genitourinary examination showed that the patient was virgin.
So we concluded that the foreign body had entered
through urethra. A decision for an intervention under general anesthesia was given. The bladder was entered with
a cystoscope, the foreign body was tried to be approached
with a forceps, however, due to the longstanding contact
with the urine, its physical structure was hampered and it
started falling into pieces, and it was extracted by inserting
the tip of the cystoscope to the open end of the pen (Figure
* Ministry of Health, Dýþkapý Yýldýrým Beyazýt Education Hospital, 3rd
Urology Clinic, Ankara, Turkey
Reprint request: Dr. A.Levent Sagnak, Angoraevleri, Altýnbel Villalarý
Hitit Bulvarý, No: 38/A, Beysukent, Ankara, Türkiye
E-mail: leventsagnak@yahoo.com
Date submitted: November 08, 2006
Accepted: January 26, 2007
OLGU SUNUMU/CASE REPORT Gülhane Týp Dergisi 2007; 49: 181-182
© Gülhane Askeri Týp Akademisi 2007
Summary
An 19-year-old female patient admitted to our clinic with
hematuria and urinary infection due to an unexpected run
of a broken head of a simple pencil to urinary bladder during erotic self stimulation. Diagnosis and treatment were
discusssed under the light of literature.
Key words: Foreign body, treatment, urinary bladder
Özet
Mesanede nadir görülen bir yabancý cisim: kalem parçasý
Erotik stimülasyon sýrasýnda kullandýðý kalem parçasý
mesane içine kaçan, üriner enfeksiyon ve kanama
nedeniyle kliniðimize baþvuran 19 yaþýnda bir bayan hastanýn taný ve tedavisi deðerlendirildi. Bu tip olgularda yaklaþým literatür eþliðinde tartýþýldý.
Anahtar kelimeler: Yabancý cisim, tedavi, mesane182 · Eylül 2007 · Gülhane TD Ersoy ve ark.
3).
Discussion
Intravesical foreign bodies are rare instances concerning
the diseases of the lower urinary system. Although both
the diagnosis and the treatment are easy, when not considered, the differential diagnosis might create a problem.
When the relevant literature was evaluated, in patients
who employ such an approach for sexual satisfaction,
shame is a common feeling and they refrain from referring
to a physician (1). These patients are frequently confronted with the irritative complaints of the bladder (dysuria,
hematuria, frequency) (1,3). In our case, the patient made
such an attempt for sexual pleasure.
Although it might seem more difficult, such instances
have been reported for males as well. When a literature
search was made, several objects, even a watch have been
reported in the bladder (1,4).
It is very easy to identify foreign bodies. Direct X-ray
graphies demonstrate nearly all foreign bodies. When necessary, complementary techniques such as intravenous
pyelography and ultrasonography can be employed. For
definitive diagnosis, cystoscopy should be performed.
Foreign body should be totally extracted with the least
possible harm to the urinary bladder and the urethra (5). A
forceps will usually be sufficient for catching the object.
However as the metallic component of the foreign body
was affected due to a long stay in the bladder, it fell into
pieces when approached with a forceps. Thus, the piece of
pen could be extracted by inserting the tip of the cystoscope to its open end. Depending on the features of the foreign bodies, different techniques may be employed. First
choice should be treatment with endoscopic approach.
Open surgical approach should be the last resort after all
other techniques have proven to be unsuccessful.