Challenges in the Diagnosis of Bladder Stones Formed by Foreign Bodies: A Report of Five Cases and Literature Review

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Herein,we have elaborated on the diagnosis, management, and outcomes of five cases of foreign body-induced BSs, including the clinical characteristics,features of multiple diagnostic imaging methods, and treatmentstrategies. Patients and methods: Between May 2016 and March 2025, there were five adult patients (four men and one woman) enrolled into the currentstudy (Table 1). The patients mainly presented with lower urinary tractsymptoms (LUTS) such as frequent urination, urgency, and dysuria. Results: The first patient was diagnosed with a bladder stone formed by aforeign body before surgery. This was confirmed during surgery. Three maining four cases were diagnosed intraoperatively with BSs formed byforeign bodies. There were various types of foreign bodies (Table 1),including green braided cord, intrauterine device (IUD), white plasticpipe, cloth fragment, and magnetic beads. The operations were performed effectively, and no complications occurred in all cases.Patients’ symptoms disappeared after surgical removal of the BSs. Conclusions: In female patients with a history of IUD insertion, the potential for intravesical migration of the device should be taken into consideration. For young to middle-aged male patients diagnosed with BSs, after ruling out benign prostatic hyperplasia(BPH) and urethralstricture, the possibility that the BSs have formed secondary to foreign bodies should be considered.The diagnosis of foreign body-induced BS srequires confirmation by a combination of multiple imaging modalities.Standing position kidney-ureter-bladder (KUB) radiography plays an important role in this diagnosis: due to gravity, typical bladder stones arelocated at the lowest part of the bladder. Therefore, the position offoreign body-induced BSs may be abnormal，e.g., Case 2 and Case 4. Their management requires accurate diagnosis based on modern imagingtechniques and tailored surgical intervention. bladder stone(BS) foreign body intrauterine device(IUD) kidney and upper bladder(KUB) Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction BSs formed by foreign bodies are a rare condition, and diagnosing them can sometimes prove challenging[ 1 ]. Foreign bodies insertion into the lower urinary tract (LUT) are often associated with youngster‌s, although this phenomenon occurs in both male and female patients across a wide age range[2–6]. The primary reasons for intravesical foreign body insertion is mainly associated sexual exploration, mental illness, or borderline personality disorder[7,8]. These foreign bodies are typically propelled into the bladder either by attempts to push them further into the urethra for removal or by involuntary contraction of the perineal muscles[1,9,10]. Most patients seek medical attention immediately or within a few days of insertion. However, chronic retention of foreign bodies in the bladder does occur, albeit rarely reported, and can cause UTIs and even lead to the formation of bladder stones[11]. The prevalence of BSs in female patients is low, and such cases are usually associated with foreign bodies or urinary stasis. Spontaneous migration of an IUD into the bladder is a rare complication. Herein, we present five cases of BSs formed by foreign bodies between May 2016 and March 2025. The study was approved by the Ethics Committee of Luohu Hospital Group Luohu People’s Hospital, and Longhua District Central Hospital. Among the five patients, one was preoperatively diagnosed with foreign body-induced bladder stones, while four were diagnosed intraoperatively. All patients underwent surgical intervention for foreign body removal. This clinical study aimed to explore the accurate preoperative diagnosis of foreign body-induced bladder stones. Case Descriptions Case 1 The first patient was a 41-year-old unmarried male. He was admitted to our hospital due to recurrent fever for 3 weeks, accompanied by abdominal pain, diarrhea, and weight loss for 1 week, and presented with a low-grade fever (37.8℃). He had a 3-year history of frequent micturition, urinary urgency, and dysuria. Physical examination revealed tenderness in both costovertebral angles (positive renal punch tenderness) and mild edema of the face and bilateral lower extremities. Outpatient laboratory results were as follows: white blood cell (WBC) count 34.9 × 10⁹/L (reference range: 3.5–9.5 × 10⁹/L), neutrophil percentage 86% (reference range: 51–75%), platelet (PLT) count 459 × 10⁹/L (reference range: 125–350 × 10⁹/L), and hemoglobin (Hb) 95 g/L (reference range: 120–160 g/L). Urinalysis showed a WBC count of 2356/μL (reference range: 0–20/μL), with urinary protein and occult blood tests positive. After admission to the hospital, the results of biochemical tests were as follows: total protein 59.5 g/L (reference range: 63–82 g/L), albumin 28.5 g/L (reference range: 35–50 g/L), urea nitrogen 22.95 mmol/L (reference range: 3.2–7.1 mmol/L), creatinine 454 μmol/L (reference range: 71–133 μmol/L), and uric acid 623 μmol/L (reference range: 208–506 μmol/L). No abnormalities were detected in the remaining blood biochemical parameters. Midstream urine culture was positive for Proteus mirabilis (>105 cfu/mL), and blood culture was positive for multidrug-resistant Escherichia coli. Computed tomography（CT）of the urinary system demonstrated a bladder stone (50 mm × 45 mm) (Fig. 1A), accompanied by focal bladder wall thickening and bilateral renal pelvis and ureteral dilatation. In contrast, KUB radiography revealed a foreign body within the stone (51 mm × 45 mm) (Fig. 1B). The patient received symptomatic and supportive treatment, including indwelling urinary catheterization for urine drainage and antibiotic administration for infection control. After three days of treatment, laboratory tests showed a WBC count of 28.05 × 109/L, Hb 93 g/L, and a neutrophil percentage of 80.9%. Renal function tests revealed urea 19.18 mmol/L, creatinine 539 μmol/L, and uric acid 626 μmol/L. The patient was diagnosed with UTI, sepsis, acute renal failure, and electrolyte disturbance. Cystolithotomy was performed under general anesthesia. The stone measured approximately 50×45 mm in size, had a hard texture, and emitted a pungent ammonia odor (Fig. 1C). After the stone was fragmented, a green plastic braided rope (approximately 12 cm in length) was identified within the stone fragments (Fig. 1D). A drainage tube was placed in the surgical field, and the procedure was completed with the insertion of a 20-Fr three-way silicone catheter. The drainage tube was removed on the 5th postoperative day. Following 8 days of postoperative management, biochemical investigations and routine blood tests gradually returned to normal, and midstream urine culture showed negative results. The patient achieved uneventful recovery and was discharged from the hospital on the 9th postoperative day after catheter removal. 2.2 Case 2 A 31-year-old married female patient was admitted to hospital due to persistent and recurrent urinary frequency and urgency for more than two years. Approximately two weeks prior, she underwent urinary system ultrasonography (USG) at another hospital in our city, which revealed a hyperechoic lesion consistent with a bladder stone with posterior acoustic shadowing on the left lateral wall of the bladder. According to her medical history, her last pregnancy occurred six years earlier, after which she had an IUD inserted. She reported that she underwent IUD removal at a local hospital over two years ago. Physical examination findings were unremarkable. Urinalysis results were consistent with a UTI, and urine culture demonstrated growth of Escherichia coli.The supine position KUB showed a high-density opacity (12×21 mm) in the pelvic cavity (Fig. 2). Given the typical clinical manifestations and her history of IUD removal, no additional examinations were performed. She underwent lithotriptoscopy, which revealed no abnormalities other than a bladder stone. Pneumatic lithotripsy was performed on the stone. During the procedure, it was identified that the foreign body was an IUD that had partially invaded the left lateral bladder wall. An attempt was made to remove the IUD endoscopically, but this was unsuccessful. A gynecologist was consulted intraoperatively, who recommended laparoscopic exploration for IUD removal. However, the patient refused the proposed surgery and requested to undergo IUD extraction at her local hospital. Therefore, the procedure was terminated after placement of a 16-Fr Foley catheter. On the second postoperative day, the Foley catheter was removed, and the patient was discharged. During subsequent follow-up, it was confirmed that the patient had undergone successful IUD removal at her local hospital. 2.3 Case 3 A 50-year-old married male patient was admitted to our hospital with a diagnosis of "bladder stone, UTI, and cholecystolithiasis". He complained of increased urinary frequency, urgent urination, and a feeling of incomplete voiding for approximately 2 years. His physical examination findings were unremarkable. Hematological and biochemical tests revealed no abnormalities. Urinalysis results indicated a UTI, while urine culture was negative. CT demonstrated a bladder stone measuring approximately 40×40 mm (Fig. 3). Cystoscopic lithotripsy was performed for the treatment of the bladder stone. During the operation, after fragmentation of the bladder stone using a holmium laser, an 8-cm-long white plastic tube was identified within the stone. The operation was completed with the placement of a 16-Fr Foley catheter. The Foley catheter was removed on the first postoperative day, and the patient was discharged. 2.4 Case 4 A 57-year-old married male patient was admitted to our hospital due to frequent urination, urinary urgency, and dysuria that he had been experiencing for 3 years. The patient had undergone a total of five cystoscopic lithotripsy procedures at other hospitals over the preceding 3 years . No history of foreign body insertion was reported by the patient. His physical examination findings were unremarkable. Urinalysis indicated a UTI, whereas midstream urine culture yielded negative results. USG revealed a hyperechoic lesion consistent with a bladder stone (13×9 mm) with posterior acoustic shadowing in the left bladder(Fig. 4A). CT demonstrated a 15×10 mm hyperdense opacity compatible with a bladder stone (Fig. 4B). Following treatment for the UTI, the patient underwent cystoscopic lithotripsy for bladder stone management. During the operation, a yellowish stone with a diameter of 15 mm was identified on the left lateral wall of the bladder, which was adherent to the bladder mucosa (Fig. 4C). After fragmentation of the bladder stone using a holmium laser, a cloth-like foreign body was visualized within the stone. This foreign body was tightly adherent to the left bladder wall and could not be extracted with bladder forceps; therefore, laparoscopic cystotomy was planned. A transverse incision was made in the bladder, and a piece of cloth fragment was removed (Fig. 4D). Following adequate closure of the bladder, a drain was placed in the surgical field, and the operation was completed with the insertion of a 16-Fr Foley catheter. The drain was removed on the 4th postoperative day, and the patient was discharged after catheter removal on the 5th postoperative day. 2.5 Case 5 An 18-year-old unmarried male patient was admitted with complaints of recurrent UTI, along with dysuria and urinary pain for 2 months. He also complained of recurring macroscopic hematuria recently. He also recently complained of recurring macroscopic hematuria, reporting that the symptoms worsened with increased physical activity. The patient denied a history of foreign body insertion. Physical examination revealed mild tenderness in the suprapubic region (bladder area). Urinalysis confirmed a UTI, and urine culture identified Escherichia coli. The patient was subsequently referred to a urologist, and a urinary color Doppler ultrasound was performed due to suspicion of BSs (Fig. 5A). Given the typical clinical manifestations, no additional examinations were conducted. The patient underwent holmium laser lithotripsy under cystoscope. During the operation, it was found that the bladder stone was rusty and adhered magnetic beads, which could not be removed under endoscopy. Therefore,suprapubic cystectomy was planned. A transverse incision was made to open the bladder,and the magnetic beads mass (7.5 x 5.5 x 3.5 cm3, with each bead measuring 5 mm in diameter) ,covered by calcification and crystals, was resected(Fig.5B). After the bladder was closed properly, a drain was placed in the surgical field, and the operation was terminated by placing a 16-Fr Foley catheter.After his drain was removed on the third day, and the patient was discharged after the catheter was removed on the fifth postoperative day. There were no reports of LUTS during the follow-up period of at least six months, nor other postoperative complications.The first patient was lost to follow-up six months after surgery. The other four patients remain under follow-up without further complication Discussion Based on etiology, BSs are classified into as primary, secondary[ 12 ]. Primary BSs typically develop in the absence of other urinary tract pathologies. Secondary BSs generally occur in the setting of other urinary tract abnormalities, such as BPH, neurogenic bladder dysfunction, bladder diverticula, or bladder foreign bodies. Clinically, most BSs are secondary, arising from upper urinary tract stones, urinary stasis, or recurrent infections[ 13 – 15 ]. The foreign bodies in the bladder are of various types[ 16 , 17 ]. Almost every conceivable object can find its way into the bladder, from IUD (Fig. 2 ), magnetic beads (Fig. 5 B), thermometers, plastic electric wires, cloth fragment (Fig. 4 D), and earpicks to animals such as schistosomes, trichomonads, and leeches[ 1 , 18 ]. Most patients (4/5, 80%) were unwilling to self report a foreign body in our study. BSs are not common in young and middle-aged individuals. When evaluating a young and middle-aged patient with recurrent lower urinary tract symptoms (LUTS), a bladder foreign body should be suspected[ 19 ]. It is essential to consider sexual curiosity or gratification as causes of foreign bodies, especially in the sexual repression population. Approximately 5% of BSs occur in women and are usually associated with foreign bodies or urinary stasis [ 20 ]. Complications of bladder foreign bodies include cystitis, foreign body-centered stones or calcification, urethral injury, urethral stricture, and obstructive uropathy (obstruction secondary to the foreign body or stones)[ 19 – 21 ].In our study, all cases had UTI, and cystitis was confirmed by urine examination and cystoscopy. The surface of all foreign bodies was covered with calcification or crystals. Furthermore, intravesical foreign bodies cause lower urinary tract obstruction symptoms, such as dysuria and interrupted urination. All these complications are related to the long-term retention of foreign bodies in the LUT[ 10 , 17 , 21 ]. Most patients with bladder foreign bodies seek medical attention immediately or a few days after by consulting a physician. However, chronic retention of foreign bodies in the bladder do occur but are rarely reported, and tend to cause bladder stone even renal failure.Therefore, it should be kept in mind that one of the rare causes of recurrent UTIs is foreign bodies in the bladder. Based on the existing literature[ 13 – 15 , 22 ] and our five cases,four male patients were unwilling to self report a foreign body. Case 4 had undergone a total of five cystoscopic lithotripsy procedures at other hospitals prior to seeking treatment at our hospital. We consider that these patients are often diagnosed late, and their quality of life is negatively impacted. Therefore, we believe that if female patients presenting with recurrent UTIs have a history of IUD placement, this should be regarded as a risk factor, necessitating a detailed evaluation. Clinical studies have noted that BSs can initially be misdiagnosed due to unclear symptoms, so timely and accurate diagnosis is crucial, particularly for old or debilitated patients. Clinically, several imaging examinations are used in the diagnosis of BS(Table 2), including KUB X-ray films,ultrasonography, CT and Magnetic Resonance Imaging(MRI), each with its own advantages and limitations.Ultrasound is used as the primary diagnostic imaging tool. It is safe, repeatable, and cost-effective. CT is a safe and accurate method for the diagnosis of negative stones; non-contrast-enhanced CT allows for the determination of stone diameter and density. CT allows for rapid acquisition of 3D data, and information on stone size and density, skin-to-stone distance, and surrounding anatomical structures, but is associated with increased radiation exposure—this is its primary limitation, particularly in pediatric populations[ 23 ].KUB is helpful in differentiating between radiolucent and radiopaque stones and should be used for comparison during follow-up. In the first case of our study, urinary system CT revealed a bladder stone (Fig. 1 a), while KUB identified foreign bodies within the stone. Thus, KUB plays an important role in diagnosing BSs formed by foreign bodies. Due to gravitational forces, BS will be located at the lowest point of the bladder on the standing position KUB,therefore, the position of bladder stones formed by foreign bodies may be abnormal. MRI is uncommonly used in urinary stones, furthermore, MRI is more expensive and time-consuming[ 24 ]. Treatment was selected according to the bladder stone's size, shape, and material. It is often removed endoscopically[ 22 , 25 ].Treatment options for BSs vary and can be treated with endoscopic or suprapubic cystolithotripsy.However, in cases of large stone development, an open or laparoscopic cystolithotomy may be required[ 26 ]. In our study,only one case was managed endoscopically.The other four cases underwent open or laparoscopic cystolithotomy for BSs removal. Prior to surgery, patients should be informed that endoscopic removal of BSs may not always be feasible and that open or laparoscopic surgery may be required. Conclusion Detailed medical history inquiry is particularly important in the diagnosis of BSs formed by foreign bodies.It is important not to assume that bladder stones are simple, but rather to perform several imaging evaluations and carefully plan a treatment strategy.Sexual medicine education is essential for preventing long-term retention of externally introduced objects in young and middle-aged males.Furthermore, the importance of prompt and continual monitoring of women using IUDs should be emphasized to detect significant adverse effects. Abbreviations BSs = bladder stones LUTS = lower urinary tract symptoms LUT = lower urinary tract IUD = intrauterine device BPH = benign prostatic hyperplasia KUB = kidney-ureter-bladder UTIs = urinary tract infections UTI = urinary tract infection WBC = white blood cell PLT = platelet Hb = hemoglobin CT = computed tomography USG = ultrasonography MRI = Magnetic Resonance Imaging Declarations Acknowledgements We express our heartfelt gratitude to all the participants who made this study possible. Author contributions ZZJ and XX prepared the manuscript. JQF and BHL collected the medical records. BHL and NXL provided the fgure. ZZJ and GXH reviewed the manuscript. ZZJ and GXH performed the surgery and provided constructive suggestions. All authors read and approved the fnal manuscript. Funding The authors disclosed receipt of the following ffnancial support for the research, authorship, and/or publication of this article: This work were funded by grants from S Shenzhen Key Medical Discipline, Shenzhen Key Medical Discipline Construction Fund (SZXK021), and Shenzhen Municipal Government’s “Three Major Projects in Medical and Health Care”(SZSM202201024). Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Ethics approval and consent to participate The study was approved by the Ethics Committee of Luohu Hospital Group Luohu People’s Hospital, and Longhua District Central Hospital. Consent for publication Written informed consent was obtained from the patients for publication of those case reports and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9072031","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":617764019,"identity":"d93160ff-c6ec-41b0-89c6-d171eb4bcc49","order_by":0,"name":"Zejian Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACNvb+Bwc+VNgw27c3EKmFj+cM48MZZ9LYDXgOEKlFTiKH2Zi37TC/gUQCsQ7jOXtMgreNWdpc8vHGGww1NtGEtbD3pUlInGMztpydVmzBcCwtt4GwLQfMJAzKeJIZbueYSTA2HCZCi0SCmUQCm0R9w80zRGvJMTY40GbAbHCDh1gtPMcSHzacSWCW7AH6JYEYv8i3Nx84/KfiPzM/++GNNz7U2BDWggyIjxokLaTqGAWjYBSMgpEBAHPRPnmtrBxIAAAAAElFTkSuQmCC","orcid":"","institution":"The Third Afffliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Zejian","middleName":"","lastName":"Zhang","suffix":""},{"id":617764020,"identity":"7b3da150-f02a-4d6b-a41c-5e1705c7e7ad","order_by":1,"name":"Jiqing Fan","email":"","orcid":"","institution":"Shenzhen Longhua District Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiqing","middleName":"","lastName":"Fan","suffix":""},{"id":617764021,"identity":"0efdd793-9419-4bc7-936c-58ea2f9c6af2","order_by":2,"name":"Baihao Lv","email":"","orcid":"","institution":"Shenzhen Longhua District Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Baihao","middleName":"","lastName":"Lv","suffix":""},{"id":617764022,"identity":"ecfa840d-1b3f-40f5-bdd7-b6a1d3098a88","order_by":3,"name":"Nanxin Liu","email":"","orcid":"","institution":"The Third Afffliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nanxin","middleName":"","lastName":"Liu","suffix":""},{"id":617764023,"identity":"f9ef38e4-e565-4aad-9eb1-609269bdb416","order_by":4,"name":"Xing Xiong","email":"","orcid":"","institution":"The Third Afffliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xing","middleName":"","lastName":"Xiong","suffix":""},{"id":617764024,"identity":"4c8daa06-f336-48c8-9480-2733c18ea6ca","order_by":5,"name":"Guixiao Huang","email":"","orcid":"","institution":"The Third Afffliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guixiao","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2026-03-09 11:09:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9072031/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9072031/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106469047,"identity":"5c19ee96-2c50-4279-9385-557628198f6a","added_by":"auto","created_at":"2026-04-09 00:45:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":934628,"visible":true,"origin":"","legend":"\u003cp\u003eA 41-year-old middle-aged male presented with severe lower urinary tract symptoms. (A) Computed tomography (CT) scan of the urinary system reveals a bladder stone (50 mm × 45 mm); (B) Kidney-ureter-bladder (KUB) radiography demonstrates a foreign body within the stone (51 mm × 45 mm); (C) The stone, measuring approximately 50 × 45 mm, had a hard texture and emitted a pungent ammonia odor; (D) After stone fragmentation, a green plastic braided rope was identified inside the stone.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9072031/v1/62077d521509c8c52f29225c.png"},{"id":106959748,"identity":"c790df00-3aa1-43f3-b4f9-9ea8b864114f","added_by":"auto","created_at":"2026-04-15 09:14:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":263487,"visible":true,"origin":"","legend":"\u003cp\u003eA 31-year-old multipara presented with persistent and recurrent urinary frequency and urgency for over two years. The Kidney-ureter-bladder (KUB) radiograph in the supine position reveals a high-density opacity (12×21 mm) in the pelvic cavity. The IUD was visualised within the pelvic cavity.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9072031/v1/0748e51f8e70c4f8f45b3ea0.png"},{"id":106724354,"identity":"2578f8a6-bbb9-450f-a61b-084a59ceb7da","added_by":"auto","created_at":"2026-04-12 18:27:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":433521,"visible":true,"origin":"","legend":"\u003cp\u003eA 50-year-old married male patient presented with recurrent lower urinary tract symptoms. Computed tomography (CT) revealed a bladder stone with a size of approximately 40 × 40 mm.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9072031/v1/7dce95c1fd9b7fab81e10593.png"},{"id":106469049,"identity":"abdcfd62-bbe4-4039-abde-8e91c3047f4a","added_by":"auto","created_at":"2026-04-09 00:45:34","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":831349,"visible":true,"origin":"","legend":"\u003cp\u003eA 57-year-old married male patient presented with frequent lower urinary tract symptoms. (A) Urinary system ultrasonography (USG) showed findings consistent with a hyperechoic stone (13×9 mm); (B) Computed tomography (CT) revealed a 15×10 mm opacity consistent with a bladder stone; (C) A yellow stone with a diameter of 15 mm was identified on the left wall of the bladder; (D) A piece of cloth fragment was retrieved.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9072031/v1/00350c2ccae63529892ca70a.png"},{"id":106469051,"identity":"51522c20-96ca-4128-8317-dbaa76fefa1d","added_by":"auto","created_at":"2026-04-09 00:45:34","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":616858,"visible":true,"origin":"","legend":"\u003cp\u003eAn 18-year-old young man presented with severe urinary irritative symptoms for two months. A) Color Doppler ultrasound showed bladder stones preoperatively; B) A calcification- and crystal-covered mass composed of magnetic beads (7.5 × 5.5 × 3.5 cm3; each bead with a diameter of 5 mm) was removed via suprapubic cystectomy.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9072031/v1/c75f8e61657c0f79429b1a2b.png"},{"id":109016170,"identity":"c0a202d5-c451-4b32-b50a-b9c23bf5130f","added_by":"auto","created_at":"2026-05-11 17:41:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4831257,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9072031/v1/ab6ef437-e4b5-4a2e-a410-60485e1f4525.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Challenges in the Diagnosis of Bladder Stones Formed by Foreign Bodies: A Report of Five Cases and Literature Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBSs formed by foreign bodies are a rare condition, and diagnosing them can sometimes prove challenging[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Foreign bodies insertion into the lower urinary tract (LUT) are often associated with youngster\u0026zwnj;s, although this phenomenon occurs in both male and female patients across a wide age range[2\u0026ndash;6]. The primary reasons for intravesical foreign body insertion is mainly associated sexual exploration, mental illness, or borderline personality disorder[7,8]. These foreign bodies are typically propelled into the bladder either by attempts to push them further into the urethra for removal or by involuntary contraction of the perineal muscles[1,9,10]. Most patients seek medical attention immediately or within a few days of insertion. However, chronic retention of foreign bodies in the bladder does occur, albeit rarely reported, and can cause UTIs and even lead to the formation of bladder stones[11]. The prevalence of BSs in female patients is low, and such cases are usually associated with foreign bodies or urinary stasis. Spontaneous migration of an IUD into the bladder is a rare complication.\u003c/p\u003e \u003cp\u003eHerein, we present five cases of BSs formed by foreign bodies between May 2016 and March 2025. The study was approved by the Ethics Committee of Luohu Hospital Group Luohu People\u0026rsquo;s Hospital, and Longhua District Central Hospital. Among the five patients, one was preoperatively diagnosed with foreign body-induced bladder stones, while four were diagnosed intraoperatively. All patients underwent surgical intervention for foreign body removal. This clinical study aimed to explore the accurate preoperative diagnosis of foreign body-induced bladder stones.\u003c/p\u003e"},{"header":"Case Descriptions","content":"\u003cp\u003e\u003cstrong\u003eCase 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first patient was a 41-year-old unmarried male. He was admitted to our hospital due to recurrent fever for 3 weeks, accompanied by abdominal pain, diarrhea, and weight loss for 1 week, and presented with a low-grade fever (37.8℃). He had a 3-year history of frequent micturition, urinary urgency, and dysuria. Physical examination revealed tenderness in both costovertebral angles (positive renal punch tenderness) and mild edema of the face and bilateral lower extremities. Outpatient laboratory results were as follows: white blood cell (WBC) count 34.9 \u0026times; 10⁹/L (reference range: 3.5\u0026ndash;9.5 \u0026times; 10⁹/L), neutrophil percentage 86% (reference range: 51\u0026ndash;75%), platelet (PLT) count 459 \u0026times; 10⁹/L (reference range: 125\u0026ndash;350 \u0026times; 10⁹/L), and hemoglobin (Hb) 95 g/L (reference range: 120\u0026ndash;160 g/L). Urinalysis showed a WBC count of 2356/\u0026mu;L (reference range: 0\u0026ndash;20/\u0026mu;L), with urinary protein and occult blood tests positive.\u003c/p\u003e\n\u003cp\u003eAfter admission to the hospital, the results of biochemical tests were as follows: total protein 59.5 g/L (reference range: 63\u0026ndash;82 g/L), albumin 28.5 g/L (reference range: 35\u0026ndash;50 g/L), urea nitrogen 22.95 mmol/L (reference range: 3.2\u0026ndash;7.1 mmol/L), creatinine 454 \u0026mu;mol/L (reference range: 71\u0026ndash;133 \u0026mu;mol/L), and uric acid 623 \u0026mu;mol/L (reference range: 208\u0026ndash;506 \u0026mu;mol/L). No abnormalities were detected in the remaining blood biochemical parameters. Midstream urine culture was positive for Proteus mirabilis (\u0026gt;105 cfu/mL), and blood culture was positive for multidrug-resistant Escherichia coli. Computed tomography（CT）of the urinary system demonstrated a bladder stone (50 mm \u0026times; 45 mm) (Fig. 1A), accompanied by focal bladder wall thickening and bilateral renal pelvis and ureteral dilatation. In contrast, KUB radiography revealed a foreign body within the stone (51 mm \u0026times; 45 mm) (Fig. 1B). The patient received symptomatic and supportive treatment, including indwelling urinary catheterization for urine drainage and antibiotic administration for infection control. After three days of treatment, laboratory tests showed a WBC count of 28.05 \u0026times; 109/L, Hb 93 g/L, and a neutrophil percentage of 80.9%. Renal function tests revealed urea 19.18 mmol/L, creatinine 539 \u0026mu;mol/L, and uric acid 626 \u0026mu;mol/L. The patient was diagnosed with UTI, sepsis, acute renal failure, and electrolyte disturbance.\u003c/p\u003e\n\u003cp\u003eCystolithotomy was performed under general anesthesia. The stone measured approximately 50\u0026times;45 mm in size, had a hard texture, and emitted a pungent ammonia odor (Fig. 1C). After the stone was fragmented, a green plastic braided rope (approximately 12 cm in length) was identified within the stone fragments (Fig. 1D). A drainage tube was placed in the surgical field, and the procedure was completed with the insertion of a 20-Fr three-way silicone catheter. The drainage tube was removed on the 5th postoperative day. Following 8 days of postoperative management, biochemical investigations and routine blood tests gradually returned to normal, and midstream urine culture showed negative results. The patient achieved uneventful recovery and was discharged from the hospital on the 9th postoperative day after catheter removal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Case 2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 31-year-old married female patient was admitted to hospital due to persistent and recurrent urinary frequency and urgency for more than two years. Approximately two weeks prior, she underwent urinary system ultrasonography (USG) at another hospital in our city, which revealed a hyperechoic lesion consistent with a bladder stone with posterior acoustic shadowing on the left lateral wall of the bladder. According to her medical history, her last pregnancy occurred six years earlier, after which she had an IUD inserted. She reported that she underwent IUD removal at a local hospital over two years ago. Physical examination findings were unremarkable. Urinalysis results were consistent with a UTI, and urine culture demonstrated growth of Escherichia coli.The supine position KUB showed a high-density opacity (12\u0026times;21 mm) in the pelvic cavity (Fig. 2). Given the typical clinical manifestations and her history of IUD removal, no additional examinations were performed.\u003c/p\u003e\n\u003cp\u003eShe underwent lithotriptoscopy, which revealed no abnormalities other than a bladder stone. Pneumatic lithotripsy was performed on the stone. During the procedure, it was identified that the foreign body was an IUD that had partially invaded the left lateral bladder wall. An attempt was made to remove the IUD endoscopically, but this was unsuccessful. A gynecologist was consulted intraoperatively, who recommended laparoscopic exploration for IUD removal. However, the patient refused the proposed surgery and requested to undergo IUD extraction at her local hospital. Therefore, the procedure was terminated after placement of a 16-Fr Foley catheter. On the second postoperative day, the Foley catheter was removed, and the patient was discharged. During subsequent follow-up, it was confirmed that the patient had undergone successful IUD removal at her local hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Case 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 50-year-old married male patient was admitted to our hospital with a diagnosis of \u0026quot;bladder stone, UTI, and cholecystolithiasis\u0026quot;. He complained of increased urinary frequency, urgent urination, and a feeling of incomplete voiding for approximately 2 years. His physical examination findings were unremarkable. Hematological and biochemical tests revealed no abnormalities. Urinalysis results indicated a UTI, while urine culture was negative. CT demonstrated a bladder stone measuring approximately 40\u0026times;40 mm (Fig. 3). Cystoscopic lithotripsy was performed for the treatment of the bladder stone. During the operation, after fragmentation of the bladder stone using a holmium laser, an 8-cm-long white plastic tube was identified within the stone. The operation was completed with the placement of a 16-Fr Foley catheter. The Foley catheter was removed on the first postoperative day, and the patient was discharged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Case 4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 57-year-old married male patient was admitted to our hospital due to frequent urination, urinary urgency, and dysuria that he had been experiencing for 3 years. The patient had undergone a total of five cystoscopic lithotripsy procedures at other hospitals over the preceding 3 years . No history of foreign body insertion was reported by the patient. His physical examination findings were unremarkable. Urinalysis indicated a UTI, whereas midstream urine culture yielded negative results. USG revealed a hyperechoic lesion consistent with a bladder stone (13\u0026times;9 mm) with posterior acoustic shadowing in the left bladder(Fig. 4A). CT demonstrated a 15\u0026times;10 mm hyperdense opacity compatible with a bladder stone (Fig. 4B).\u003c/p\u003e\n\u003cp\u003eFollowing treatment for the UTI, the patient underwent cystoscopic lithotripsy for bladder stone management. During the operation, a yellowish stone with a diameter of 15 mm was identified on the left lateral wall of the bladder, which was adherent to the bladder mucosa (Fig. 4C). After fragmentation of the bladder stone using a holmium laser, a cloth-like foreign body was visualized within the stone. This foreign body was tightly adherent to the left bladder wall and could not be extracted with bladder forceps; therefore, laparoscopic cystotomy was planned. A transverse incision was made in the bladder, and a piece of cloth fragment was removed (Fig. 4D). Following adequate closure of the bladder, a drain was placed in the surgical field, and the operation was completed with the insertion of a 16-Fr Foley catheter. The drain was removed on the 4th postoperative day, and the patient was discharged after catheter removal on the 5th postoperative day.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Case 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn 18-year-old unmarried male patient was admitted with complaints of recurrent UTI, along with dysuria and urinary pain for 2 months. He also complained of recurring macroscopic hematuria recently. He also recently complained of recurring macroscopic hematuria, reporting that the symptoms worsened with increased physical activity. The patient denied a history of foreign body insertion. Physical examination revealed mild tenderness in the suprapubic region (bladder area). Urinalysis confirmed a UTI, and urine culture identified Escherichia coli. The patient was subsequently referred to a urologist, and a urinary color Doppler ultrasound was performed due to suspicion of BSs (Fig. 5A). Given the typical clinical manifestations, no additional examinations were conducted.\u003c/p\u003e\n\u003cp\u003eThe patient underwent holmium laser lithotripsy under cystoscope. During the operation, it was found that the bladder stone was rusty and adhered magnetic beads, which could not be removed under endoscopy. Therefore,suprapubic cystectomy was planned. A transverse incision was made to open the bladder,and the magnetic beads mass (7.5 x 5.5 x 3.5 cm3, with each bead measuring 5 mm in diameter) ,covered by calcification and crystals, was resected(Fig.5B). After the bladder was closed properly, a drain was placed in the surgical field, and the operation was terminated by placing a 16-Fr Foley catheter.After his drain was removed on the third day, and the patient was discharged after the catheter was removed on the fifth postoperative day.\u003c/p\u003e\n\u003cp\u003eThere were no reports of LUTS during the follow-up period of at least six months, nor other postoperative complications.The first patient was lost to follow-up six months after surgery. The other four patients remain under follow-up without further complication\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on etiology, BSs are classified into as primary, secondary[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Primary BSs typically develop in the absence of other urinary tract pathologies. Secondary BSs generally occur in the setting of other urinary tract abnormalities, such as BPH, neurogenic bladder dysfunction, bladder diverticula, or bladder foreign bodies. Clinically, most BSs are secondary, arising from upper urinary tract stones, urinary stasis, or recurrent infections[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe foreign bodies in the bladder are of various types[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Almost every conceivable object can find its way into the bladder, from IUD (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), magnetic beads (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB), thermometers, plastic electric wires, cloth fragment (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eD), and earpicks to animals such as schistosomes, trichomonads, and leeches[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Most patients (4/5, 80%) were unwilling to self report a foreign body in our study.\u003c/p\u003e \u003cp\u003eBSs are not common in young and middle-aged individuals. When evaluating a young and middle-aged patient with recurrent lower urinary tract symptoms (LUTS), a bladder foreign body should be suspected[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is essential to consider sexual curiosity or gratification as causes of foreign bodies, especially in the sexual repression population. Approximately 5% of BSs occur in women and are usually associated with foreign bodies or urinary stasis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComplications of bladder foreign bodies include cystitis, foreign body-centered stones or calcification, urethral injury, urethral stricture, and obstructive uropathy (obstruction secondary to the foreign body or stones)[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].In our study, all cases had UTI, and cystitis was confirmed by urine examination and cystoscopy. The surface of all foreign bodies was covered with calcification or crystals. Furthermore, intravesical foreign bodies cause lower urinary tract obstruction symptoms, such as dysuria and interrupted urination. All these complications are related to the long-term retention of foreign bodies in the LUT[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost patients with bladder foreign bodies seek medical attention immediately or a few days after by consulting a physician. However, chronic retention of foreign bodies in the bladder do occur but are rarely reported, and tend to cause bladder stone even renal failure.Therefore, it should be kept in mind that one of the rare causes of recurrent UTIs is foreign bodies in the bladder. Based on the existing literature[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and our five cases,four male patients were unwilling to self report a foreign body. Case 4 had undergone a total of five cystoscopic lithotripsy procedures at other hospitals prior to seeking treatment at our hospital. We consider that these patients are often diagnosed late, and their quality of life is negatively impacted. Therefore, we believe that if female patients presenting with recurrent UTIs have a history of IUD placement, this should be regarded as a risk factor, necessitating a detailed evaluation.\u003c/p\u003e \u003cp\u003eClinical studies have noted that BSs can initially be misdiagnosed due to unclear symptoms, so timely and accurate diagnosis is crucial, particularly for old or debilitated patients. Clinically, several imaging examinations are used in the diagnosis of BS(Table\u0026nbsp;2), including KUB X-ray films,ultrasonography, CT and Magnetic Resonance Imaging(MRI), each with its own advantages and limitations.Ultrasound is used as the primary diagnostic imaging tool. It is safe, repeatable, and cost-effective. CT is a safe and accurate method for the diagnosis of negative stones; non-contrast-enhanced CT allows for the determination of stone diameter and density. CT allows for rapid acquisition of 3D data, and information on stone size and density, skin-to-stone distance, and surrounding anatomical structures, but is associated with increased radiation exposure\u0026mdash;this is its primary limitation, particularly in pediatric populations[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].KUB is helpful in differentiating between radiolucent and radiopaque stones and should be used for comparison during follow-up. In the first case of our study, urinary system CT revealed a bladder stone (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea), while KUB identified foreign bodies within the stone. Thus, KUB plays an important role in diagnosing BSs formed by foreign bodies. Due to gravitational forces, BS will be located at the lowest point of the bladder on the standing position KUB,therefore, the position of bladder stones formed by foreign bodies may be abnormal. MRI is uncommonly used in urinary stones, furthermore, MRI is more expensive and time-consuming[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTreatment was selected according to the bladder stone's size, shape, and material. It is often removed endoscopically[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].Treatment options for BSs vary and can be treated with endoscopic or suprapubic cystolithotripsy.However, in cases of large stone development, an open or laparoscopic cystolithotomy may be required[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study,only one case was managed endoscopically.The other four cases underwent open or laparoscopic cystolithotomy for BSs removal. Prior to surgery, patients should be informed that endoscopic removal of BSs may not always be feasible and that open or laparoscopic surgery may be required.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDetailed medical history inquiry is particularly important in the diagnosis of BSs formed by foreign bodies.It is important not to assume that bladder stones are simple, but rather to perform several imaging evaluations and carefully plan a treatment strategy.Sexual medicine education is essential for preventing long-term retention of externally introduced objects in young and middle-aged males.Furthermore, the importance of prompt and continual monitoring of women using IUDs should be emphasized to detect significant adverse effects.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBSs = bladder stones\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLUTS = lower urinary tract symptoms\u003c/p\u003e\n\u003cp\u003eLUT = lower urinary tract\u003c/p\u003e\n\u003cp\u003eIUD = intrauterine device\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBPH = benign prostatic hyperplasia\u003c/p\u003e\n\u003cp\u003eKUB = kidney-ureter-bladder\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUTIs = urinary tract infections\u003c/p\u003e\n\u003cp\u003eUTI = urinary tract infection\u003c/p\u003e\n\u003cp\u003eWBC = white blood cell\u003c/p\u003e\n\u003cp\u003ePLT = platelet\u003c/p\u003e\n\u003cp\u003eHb = hemoglobin\u003c/p\u003e\n\u003cp\u003eCT = computed tomography\u003c/p\u003e\n\u003cp\u003eUSG = ultrasonography\u003c/p\u003e\n\u003cp\u003eMRI = Magnetic Resonance Imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our heartfelt gratitude to all the participants who made this study possible.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZZJ and XX prepared the manuscript. JQF and BHL collected the medical records. BHL and NXL provided the fgure. ZZJ and GXH reviewed the manuscript. ZZJ and GXH performed the surgery and provided constructive suggestions. All authors read and approved the fnal manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors disclosed receipt of the following ffnancial support for the research, authorship, and/or publication of this article: This work were funded by grants from S Shenzhen Key Medical Discipline, Shenzhen Key Medical Discipline Construction Fund (SZXK021), and Shenzhen Municipal Government\u0026rsquo;s \u0026ldquo;Three Major Projects in Medical and Health Care\u0026rdquo;(SZSM202201024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Luohu Hospital Group Luohu People\u0026rsquo;s Hospital, and Longhua District Central Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patients for publication of those case reports and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhang Z, Zhu X, Wang Y, Chen D, Fan J, Deng C, Liu G, Yang L, Feloney M, Wang X\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eSexual dysfunction associated with chronic retention of foreign bodies in the low urinary tract\u003c/strong\u003e. \u003cem\u003eAndrologia \u003c/em\u003e2022, \u003cstrong\u003e54\u003c/strong\u003e(3):e14346.\u003c/li\u003e\n\u003cli\u003eOuskri S, Zaoui Y, Ibrahimi A, Boualaoui I, El Sayegh H, Nouini Y: \u003cstrong\u003eUrethrovesical calcified foreign body: Case report and literature review\u003c/strong\u003e. \u003cem\u003eInt J Surg Case Rep \u003c/em\u003e2025, 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Imaging in the Diagnosis and Treatment of Urolithiasis: A Narrative Review\u003c/strong\u003e. \u003cem\u003eCureus \u003c/em\u003e2022, \u003cstrong\u003e14\u003c/strong\u003e(12):e33041.\u003c/li\u003e\n\u003cli\u003eZhang Z, Fang L, Chen D, Li W, Peng N, Thakker PU, Zhang Y, Wang X: \u003cstrong\u003eA Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury\u003c/strong\u003e. \u003cem\u003eJ Endourol \u003c/em\u003e2021, \u003cstrong\u003e35\u003c/strong\u003e(3):335-341.\u003c/li\u003e\n\u003cli\u003eWang X, Guo X, Tang Z, Ying X, Tang C, Shen R: \u003cstrong\u003eSecondary bladder stone caused by delayed penetration of the bladder by a pubic fracture: A case report and literature review\u003c/strong\u003e. \u003cem\u003eExp Ther Med \u003c/em\u003e2024, \u003cstrong\u003e27\u003c/strong\u003e(4):167.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"bladder stone(BS), foreign body, intrauterine device(IUD), kidney and upper bladder(KUB)","lastPublishedDoi":"10.21203/rs.3.rs-9072031/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9072031/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003eBladder stones (BSs) formed by foreign bodies are anuncommon disease, and their diagnosis is sometimes challenging. Herein,we have elaborated on the diagnosis, management, and outcomes of five cases of foreign body-induced BSs, including the clinical characteristics,features of multiple diagnostic imaging methods, and treatmentstrategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and methods: \u003c/strong\u003eBetween May 2016 and March 2025, there were five adult patients (four men and one woman) enrolled into the currentstudy (Table 1). The patients mainly presented with lower urinary tractsymptoms (LUTS) such as frequent urination, urgency, and dysuria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe first patient was diagnosed with a bladder stone formed by aforeign body before surgery. This was confirmed during surgery. Three maining four cases were diagnosed intraoperatively with BSs formed byforeign bodies. There were various types of foreign bodies (Table 1),including green braided cord, intrauterine device (IUD), white plasticpipe, cloth fragment, and magnetic beads. The operations were performed effectively, and no complications occurred in all cases.Patients’ symptoms disappeared after surgical removal of the BSs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e In female patients with a history of IUD insertion, the potential for intravesical migration of the device should be taken into consideration. For young to middle-aged male patients diagnosed with BSs, after ruling out benign prostatic hyperplasia(BPH) and urethralstricture, the possibility that the BSs have formed secondary to foreign bodies should be considered.The diagnosis of foreign body-induced BS srequires confirmation by a combination of multiple imaging modalities.Standing position kidney-ureter-bladder (KUB) radiography plays an important role in this diagnosis: due to gravity, typical bladder stones arelocated at the lowest part of the bladder. Therefore, the position offoreign body-induced BSs may be abnormal，e.g., Case 2 and Case 4. Their management requires accurate diagnosis based on modern imagingtechniques and tailored surgical intervention.\u003c/p\u003e","manuscriptTitle":"Challenges in the Diagnosis of Bladder Stones Formed by Foreign Bodies: A Report of Five Cases and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 00:45:30","doi":"10.21203/rs.3.rs-9072031/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d95339a6-8411-4b73-b2fc-32f8bbccbe07","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-11T17:23:45+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T17:41:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 00:45:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9072031","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9072031","identity":"rs-9072031","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}