Khat-Induced Intravesical Coiling of a Self-Inserted Urethral Serum Set: A Rare Cause of Acute Urinary Retention Requiring Open Bladder Surgery

Khat-Induced Intravesical Coiling of a Self-Inserted Urethral Serum Set: A Rare Cause of Acute Urinary Retention Requiring Open Bladder Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Khat-Induced Intravesical Coiling of a Self-Inserted Urethral Serum Set: A Rare Cause of Acute Urinary Retention Requiring Open Bladder Surgery Abdullahi Ahmed Ahmed, Khalid Ali Mohamed, Mowlid Mohamud Hassan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9175460/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Although foreign bodies in the lower urinary tract are rare, several reported cases highlight their significance, with potential causes including self-insertion into the urethra, iatrogenic factors, penetrating trauma, and migration from nearby organs. Self-insertion of objects into the urinary tract is quite rare in emergency visits, but it is one of the potential causes of acute urinary retention. Case Report: Here, we reported a 40-year-old healthy male presented to the emergency department with complaints of urinary retention and severe suprapubic pain. After a significant loss of self-awareness due to khat use, he attempted to alleviate his discomfort by inserting a foreign object. Imaging confirmed a foreign body in the bladder, identified as a coiled rubber tube via cystoscopy. Given the complexity of its configuration, open bladder surgery was required for removal. The patient responded well to treatment and was discharged after careful monitoring. The patient was recommended for psychiatric consultation and a postoperative retrograde urethrogram. Why should an emergency physician be aware of this? The identification and management of such cases can pose unique challenges, as the foreign objects may assume intricate configurations within the bladder or urethra, as demonstrated by the coiled rubber tube in the present case. Comprehensive diagnostic imaging, such as contrast enhanced CT scan and cystoscopic examination performed here, is often crucial for accurately characterizing the nature and extent of the foreign body, which then informs the appropriate treatment approach. This case highlights the importance of a thorough clinical assessment and a multidisciplinary approach in managing patients with self-inserted foreign bodies in the lower genital tract, to provide effective care and prevent potential complications. Vesical foreign body Urinary retention Kat chewing Cystoscopy Figures Figure 1 Figure 2 Figure 3 1. Introduction Self-insertion of objects into the urinary tract is quite rare in emergency visits, but it is one of the potential causes of acute urinary retention (AUR) ( 1 , 2 , 3 ). A retrospective study by Nagabhushana et al. on self-inflicted foreign bodies in the lower genitourinary tract among males found that out of 17,978 inpatients over the past six years, ten patients (0.055%) had inserted foreign objects, which ranged from seeds and twigs to electrical wires ( 4 ). A wide range of objects, including electrical wire, eyebrow pencil, tongue cleaner, nail scissor, and telephone cable have been documented as being self-inserted into the lower genital organs ( 1 , 2 , 3 , 5 , 6 ). Most studies have indicated that the primary contributing factors for self-insertion of foreign bodies in the genitourinary tract include psychiatric disorders, lack of a partner, intoxication, and autoerotic stimulation, such as masturbation ( 1 , 2 , 4 ). The clinical presentation can vary from being asymptomatic to experiencing suprapubic pain, dribbling, penile ulceration with discharge, external genitalia swelling, hematuria, and acute urinary retention ( 2 , 4 , 5 ). This case report describes a 40-year-old healthy male who presented with urinary retention following the self-insertion of a urethral serum set after an extended period of Kat chewing. Upon examination, a distended bladder was identified and imaging revealed a foreign body. Cystoscopy confirmed the presence of a coiled rubber tube lodged in the bladder, necessitating open urinary bladder surgery and its removal successfully. 2. Case report A 40-year-old healthy male presented to the emergency department with urinary retention after self-inserting a urethral serum set. The patient had been chewing Kat for approximately four hours before this event, during which he experienced a significant loss of self-awareness. Upon arrival at the emergency department, the patient appeared anxious but alert. Vital signs were within normal limits: blood pressure was 120/80 mmHg, heart rate was 78 beats per minute, respiratory rate was 16 breaths per minute, and temperature was 98.6°F (37°C). There were no signs of distress during the initial assessment. The patient reported an inability to urinate and severe suprapubic pain. He reported feeling an urgent need to void but, in a disoriented state, attempted to insert the serum set into the penile orifice, advancing it toward the bladder. He stated he believed this would alleviate his discomfort. On physical examination, the abdomen was soft but markedly distended in the suprapubic region. A digital rectal examination revealed a full bladder without palpable masses, and the prostate was noted to be normal in size and consistency. There were no signs of infection or external trauma. An initial ultrasound confirmed the presence of a foreign body in the urinary bladder and a significant volume of retained urine. The patient was catheterized successfully, which relieved the urinary retention. Urinalysis showed no evidence of infection or hematuria. A computer tomography (CT) scan was conducted to examine the configuration of the foreign body within the bladder. The reconstructed 3D-CT images revealed that a plastic infusion tube was intricately tangled and had taken on the shape of the bladder (Figs. 1 A, B, & C). The urology team was consulted, and a cystoscopy was performed. This revealed a coiled rubber tube lodged in the bladder (Fig. 2 ). Due to the complexity of the foreign body’s shape, open urinary bladder surgery was required for safe removal (Fig. 3 A&B). The surgery was successful, and the patient recovered well without complications. Postoperatively, the patient received isotonic 0.9% saline 500ml given twice daily for hydration, Dextrose 5% solution 500ml administered as needed for fluid and electrolyte balance, Diclofenac 75mg IM given twice daily for pain management, Esomeprazole 40mg IV administered once daily for gastrointestinal protection, and Ceftriaxone 1g IV administered twice daily for infection prophylaxis. The patient responded well to treatment and was discharged after careful monitoring. The patient was recommended for psychiatric consultation and a postoperative retrograde urethrogram but the patient did not follow up. 3. Discussion Although foreign bodies in the lower urinary tract are rare, several reported cases highlight their significance, with potential causes including self-insertion into the urethra, iatrogenic factors, penetrating trauma, and migration from nearby organs ( 4 , 7 ). A wide range of objects, including electrical wires, eyebrow pencil, tongue cleaner, nail scissor, and telephone cable have been documented as being self-inserted into the lower genital organs ( 1 , 2 , 3 , 5 , 6 ). In the context of the present case, the identification of the coiled rubber tube as a foreign body within the bladder is consistent with the wide range of unusual objects that have been previously documented as being self-inserted into the lower genital organs. The self-insertion of foreign bodies into the urethra presents a unique clinical challenge, often associated with psychiatric disorders, lack of a partner, intoxication, and autoerotic stimulation ( 1 , 2 , 4 ). In our case, the patient experienced urinary retention following the self-insertion of a urethral serum set, a situation exacerbated by extended khat chewing. Moreover, our patient had no psychological illness. Khat can induce euphoria and altered perceptions, potentially leading to impulsive behaviors. This altered mental state may contribute to decisions that individuals might not make under normal circumstances, such as the self-insertion of a foreign object into the urethra. Our patient presented with complaints of urine retention and suprapubic pain which are the commonest symptoms of intravesical foreign bodies and were aligned with the findings of other cases ( 4 , 6 , 8 ). Given that X-rays and ultrasounds are cheaper and more accessible in many clinics, contrast-enhanced CT scans are typically the preferred imaging method for detecting the presence of such objects ( 9 , 10 ). In the present case, an initial ultrasound confirmed the presence of a foreign body in the urinary bladder with a significant volume of retained urine, followed by a CT scan that revealed a plastic infusion set (Serum set), which had conformed to the shape of the bladder in the reconstructed 3D images. The definitive management of intravesical foreign bodies is their total removal through less invasive procedures either endoscopic or surgical interventions with minimal complications ( 4 ). In our case, because the foreign body was long, curled up, and impacted the bladder wall, so cystoscopic retrieval was not tried. Open bladder surgery technique is used for foreign body removal from the bladder. 4. Why should an emergency physician be aware of this? The identification and management of such cases can pose unique challenges, as the foreign objects may assume intricate configurations within the bladder or urethra, as demonstrated by the coiled rubber tube in the present case. Comprehensive diagnostic imaging, such as the cystoscopic examination performed here, is often crucial for accurately characterizing the nature and extent of the foreign body, which then informs the appropriate treatment approach. This case highlights the importance of a thorough clinical assessment and a multidisciplinary approach in managing patients with self-inserted foreign bodies in the lower genital tract, to provide effective care and prevent potential complications. Finally, this case serves as a reminder of the importance of educating patients about the risks of self-insertion and the need to seek medical help for urinary issues, particularly in the context of substance use. Overall, the case report enhances emergency physicians' skills in diagnosing and managing similar situations. Declarations Data Sharing Statement: We confirm that we have complete access to all data in this study and accept full responsibility for its integrity. Data for this study are available upon reasonable request from the corresponding author. Ethics approval: In accordance with the regulations of the review board at Mogadishu Somali Turkish Training and Research Hospital, institutional review board approval is not necessary for case reports. Consent for Publication: Written informed consent was obtained from the patient father to publish the case details and any associated images. Conflict of Interest: The authors have disclosed any financial or personal relationships with individuals or organizations that could bias their work. There are no undisclosed conflicts of interest. Authors’ contributions: All listed authors fulfil the authorship criteria specified by the journal, having significantly contributed to the conception, design, execution, or interpretation of the study. We have approved the submitted version and accept responsibility for all aspects of the work. Competing interests: We declare that we have no competing interests . Funding: We declare that we have no funding source. Acknowledgements: All those who have significantly contributed to the work detailed in the manuscript but do not fit the requirements for authorship have been acknowledged by the authors. References Tuncer H, Karacam H, Cam B. A self-inserted foreign body in the urinary bladder and urethra. Cureus. 2021 Jul;13(7). Atim T, Ejembi FA. Self-inserted foreign body in the urinary bladder following sounding: case report and review of the literature. Orient Journal of Medicine. 2019;31(3-4):136-43. Dinesh A, Singh A, Neogi S. Tongue cleaner, an unusual foreign body in the urethra: A case report. The Australasian Medical Journal. 2013;6(10):508. Mahadevappa N, Kochhar G, Vilvapathy KS, Dharwadkar S, Kumar S. Self-inflicted foreign bodies in lower genitourinary tract in males: Our experience and review of literature. Urology annals. 2016 Jul 1;8(3):338-42. Cam B, Tuncer H, Uzun O, Uysal E. Nail scissor as a rare foreign body in the urethra: case report. Cureus. 2019 Jan;11(1). Trehan RK, Haroon A, Memon S, Turner D. Successful removal of a telephone cable, a foreign body through the urethra into the bladder: a case report. Journal of medical case reports. 2007 Dec;1:1-3. Van Ophoven A, de Kernion JB. Clinical management of foreign bodies of the genitourinary tract. The Journal of urology. 2000 Aug 1;164(2):274-87. Muraveji Q, Sherzad A. Retention of a self-inserted urethral foreign body in an adolescent boy. Journal of Pediatric Surgery Case Reports. 2020 Apr 1;55:101409. Barzilai M, Cohen I, Stein A. Sonographic detection of a foreign body in the urethra and urinary bladder. Urologia internationalis. 2000 Jun 2;64(3):178-80. Cury J, Coelho RF, Srougi M. Retroperitoneal migration of a self-inflicted ballpoint pen via the urethra. International braz j urol. 2006;32:193-5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 May, 2026 Reviews received at journal 09 May, 2026 Reviews received at journal 07 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviewers agreed at journal 24 Apr, 2026 Reviewers invited by journal 22 Apr, 2026 Editor assigned by journal 21 Mar, 2026 Submission checks completed at journal 21 Mar, 2026 First submitted to journal 20 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-9175460","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":631455450,"identity":"dba56c8a-c4cc-42fc-8cc5-e2277aeba515","order_by":0,"name":"Abdullahi Ahmed Ahmed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDCCA4wPQBRjA3sDkDKwIEYLswFEC88BkBYJUrRIJIBoIrTw3T7MJvHmj51sv+Tzqxt+FEgw8Ld3J+DVInkumU1ybluy8czZOWU3e4AOkzhzdgNeLQZn+I9J8zYwJ264nZN2gweoxUAil5AWZjZpnj/1iftvnkm7+Yd4LWyHEzdIsB+7TZQtkmeYmS3nth03nnEmh+22jIEED0G/8J1hZrzx5k+1bH/78Wc33/yxkeNv78WvBQx4IKQBgk2kFvYHxKkeBaNgFIyCEQcA3QFIlS+haQAAAAAASUVORK5CYII=","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Abdullahi","middleName":"Ahmed","lastName":"Ahmed","suffix":""},{"id":631455451,"identity":"6fc78e65-35f8-49d2-b590-604b187a44ad","order_by":1,"name":"Khalid Ali Mohamed","email":"","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Khalid","middleName":"Ali","lastName":"Mohamed","suffix":""},{"id":631455452,"identity":"bc914886-1c27-4bc3-b99e-45bf27b5c195","order_by":2,"name":"Mowlid Mohamud Hassan","email":"","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mowlid","middleName":"Mohamud","lastName":"Hassan","suffix":""},{"id":631455453,"identity":"d9abf39e-e6eb-4212-b5ed-a7c1ce1146ee","order_by":3,"name":"Ismail Gedi Ibrahim","email":"","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ismail","middleName":"Gedi","lastName":"Ibrahim","suffix":""}],"badges":[],"createdAt":"2026-03-20 06:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9175460/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9175460/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108407370,"identity":"5262f29e-188b-4616-aa9d-f92e6c151fa1","added_by":"auto","created_at":"2026-05-04 09:50:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":360043,"visible":true,"origin":"","legend":"\u003cp\u003eA, B, \u0026amp; C: The 3D CT scan image views depicting an intravesical foreign body, likely a jump rope, that has conformed to the shape of the bladder (Figure A), a cross-sectional view showing the distinct structure of the foreign object within the bladder (Figure B), and the plastic infusion tubing coiled within the urethra after removal (Figure C).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9175460/v1/9f292830c50c91c91f32f457.png"},{"id":108493451,"identity":"9cb3dcd5-6254-4dda-ba7e-a81f03daefa0","added_by":"auto","created_at":"2026-05-05 10:00:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":502845,"visible":true,"origin":"","legend":"\u003cp\u003eThe cystoscopic examination revealed a coiled rubber tube lodged within the bladder, as shown in Figure 2.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9175460/v1/3d0364bdd4745a99721ce376.png"},{"id":108407371,"identity":"c3aef21c-0ada-4846-8343-b26d806ffc0c","added_by":"auto","created_at":"2026-05-04 09:50:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":770387,"visible":true,"origin":"","legend":"\u003cp\u003eA\u0026amp;B: Figure 3A shows the plastic infusion (serum set) tubing that was extracted as a foreign body through a small open cystectomy. Figure 3B depicts the plastic infusion tubing after it was removed from the bladder.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9175460/v1/a20067e2e54b8556fa15e09c.png"},{"id":108804026,"identity":"9a851316-cc20-4c50-9c84-0d988239dc2d","added_by":"auto","created_at":"2026-05-08 15:14:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2441636,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9175460/v1/dadbc0b9-57c2-462f-ab3f-111896183a36.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Khat-Induced Intravesical Coiling of a Self-Inserted Urethral Serum Set: A Rare Cause of Acute Urinary Retention Requiring Open Bladder Surgery","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSelf-insertion of objects into the urinary tract is quite rare in emergency visits, but it is one of the potential causes of acute urinary retention (AUR) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). A retrospective study by Nagabhushana et al. on self-inflicted foreign bodies in the lower genitourinary tract among males found that out of 17,978 inpatients over the past six years, ten patients (0.055%) had inserted foreign objects, which ranged from seeds and twigs to electrical wires (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A wide range of objects, including electrical wire, eyebrow pencil, tongue cleaner, nail scissor, and telephone cable have been documented as being self-inserted into the lower genital organs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Most studies have indicated that the primary contributing factors for self-insertion of foreign bodies in the genitourinary tract include psychiatric disorders, lack of a partner, intoxication, and autoerotic stimulation, such as masturbation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The clinical presentation can vary from being asymptomatic to experiencing suprapubic pain, dribbling, penile ulceration with discharge, external genitalia swelling, hematuria, and acute urinary retention (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis case report describes a 40-year-old healthy male who presented with urinary retention following the self-insertion of a urethral serum set after an extended period of Kat chewing. Upon examination, a distended bladder was identified and imaging revealed a foreign body. Cystoscopy confirmed the presence of a coiled rubber tube lodged in the bladder, necessitating open urinary bladder surgery and its removal successfully.\u003c/p\u003e"},{"header":"2. Case report","content":"\u003cp\u003eA 40-year-old healthy male presented to the emergency department with urinary retention after self-inserting a urethral serum set. The patient had been chewing Kat for approximately four hours before this event, during which he experienced a significant loss of self-awareness. Upon arrival at the emergency department, the patient appeared anxious but alert. Vital signs were within normal limits: blood pressure was 120/80 mmHg, heart rate was 78 beats per minute, respiratory rate was 16 breaths per minute, and temperature was 98.6\u0026deg;F (37\u0026deg;C). There were no signs of distress during the initial assessment. The patient reported an inability to urinate and severe suprapubic pain. He reported feeling an urgent need to void but, in a disoriented state, attempted to insert the serum set into the penile orifice, advancing it toward the bladder. He stated he believed this would alleviate his discomfort. On physical examination, the abdomen was soft but markedly distended in the suprapubic region. A digital rectal examination revealed a full bladder without palpable masses, and the prostate was noted to be normal in size and consistency. There were no signs of infection or external trauma. An initial ultrasound confirmed the presence of a foreign body in the urinary bladder and a significant volume of retained urine. The patient was catheterized successfully, which relieved the urinary retention. Urinalysis showed no evidence of infection or hematuria. A computer tomography (CT) scan was conducted to examine the configuration of the foreign body within the bladder. The reconstructed 3D-CT images revealed that a plastic infusion tube was intricately tangled and had taken on the shape of the bladder (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, B, \u0026amp; C). The urology team was consulted, and a cystoscopy was performed. This revealed a coiled rubber tube lodged in the bladder (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Due to the complexity of the foreign body\u0026rsquo;s shape, open urinary bladder surgery was required for safe removal (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA\u0026amp;B). The surgery was successful, and the patient recovered well without complications. Postoperatively, the patient received isotonic 0.9% saline 500ml given twice daily for hydration, Dextrose 5% solution 500ml administered as needed for fluid and electrolyte balance, Diclofenac 75mg IM given twice daily for pain management, Esomeprazole 40mg IV administered once daily for gastrointestinal protection, and Ceftriaxone 1g IV administered twice daily for infection prophylaxis. The patient responded well to treatment and was discharged after careful monitoring. The patient was recommended for psychiatric consultation and a postoperative retrograde urethrogram but the patient did not follow up.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eAlthough foreign bodies in the lower urinary tract are rare, several reported cases highlight their significance, with potential causes including self-insertion into the urethra, iatrogenic factors, penetrating trauma, and migration from nearby organs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A wide range of objects, including electrical wires, eyebrow pencil, tongue cleaner, nail scissor, and telephone cable have been documented as being self-inserted into the lower genital organs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In the context of the present case, the identification of the coiled rubber tube as a foreign body within the bladder is consistent with the wide range of unusual objects that have been previously documented as being self-inserted into the lower genital organs.\u003c/p\u003e \u003cp\u003eThe self-insertion of foreign bodies into the urethra presents a unique clinical challenge, often associated with psychiatric disorders, lack of a partner, intoxication, and autoerotic stimulation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In our case, the patient experienced urinary retention following the self-insertion of a urethral serum set, a situation exacerbated by extended khat chewing. Moreover, our patient had no psychological illness. Khat can induce euphoria and altered perceptions, potentially leading to impulsive behaviors. This altered mental state may contribute to decisions that individuals might not make under normal circumstances, such as the self-insertion of a foreign object into the urethra.\u003c/p\u003e \u003cp\u003eOur patient presented with complaints of urine retention and suprapubic pain which are the commonest symptoms of intravesical foreign bodies and were aligned with the findings of other cases (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven that X-rays and ultrasounds are cheaper and more accessible in many clinics, contrast-enhanced CT scans are typically the preferred imaging method for detecting the presence of such objects (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In the present case, an initial ultrasound confirmed the presence of a foreign body in the urinary bladder with a significant volume of retained urine, followed by a CT scan that revealed a plastic infusion set (Serum set), which had conformed to the shape of the bladder in the reconstructed 3D images. The definitive management of intravesical foreign bodies is their total removal through less invasive procedures either endoscopic or surgical interventions with minimal complications (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In our case, because the foreign body was long, curled up, and impacted the bladder wall, so cystoscopic retrieval was not tried. Open bladder surgery technique is used for foreign body removal from the bladder.\u003c/p\u003e"},{"header":"4. Why should an emergency physician be aware of this?","content":"\u003cp\u003eThe identification and management of such cases can pose unique challenges, as the foreign objects may assume intricate configurations within the bladder or urethra, as demonstrated by the coiled rubber tube in the present case. Comprehensive diagnostic imaging, such as the cystoscopic examination performed here, is often crucial for accurately characterizing the nature and extent of the foreign body, which then informs the appropriate treatment approach. This case highlights the importance of a thorough clinical assessment and a multidisciplinary approach in managing patients with self-inserted foreign bodies in the lower genital tract, to provide effective care and prevent potential complications. Finally, this case serves as a reminder of the importance of educating patients about the risks of self-insertion and the need to seek medical help for urinary issues, particularly in the context of substance use. Overall, the case report enhances emergency physicians' skills in diagnosing and managing similar situations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Sharing Statement:\u0026nbsp;\u003c/strong\u003eWe confirm that we have complete access to all data in this study and accept full responsibility for its integrity. Data for this study are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eIn accordance with the regulations of the review board at Mogadishu Somali Turkish Training and Research Hospital, institutional review board approval is not necessary for case reports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from the patient father to publish the case details and any associated images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors have disclosed any financial or personal relationships with individuals or organizations that could bias their work. There are no undisclosed conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eAll listed authors fulfil the authorship criteria specified by the journal, having significantly contributed to the conception, design, execution, or interpretation of the study. We have approved the submitted version and accept responsibility for all aspects of the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eWe declare that we have no competing interests\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eWe declare that we have no funding source.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eAll those who have significantly contributed to the work detailed in the manuscript but do not fit the requirements for authorship have been acknowledged by the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eTuncer H, Karacam H, Cam B. A self-inserted foreign body in the urinary bladder and urethra. Cureus. 2021 Jul;13(7).\u003c/li\u003e\n \u003cli\u003eAtim T, Ejembi FA. Self-inserted foreign body in the urinary bladder following sounding: case report and review of the literature. Orient Journal of Medicine. 2019;31(3-4):136-43.\u003c/li\u003e\n \u003cli\u003eDinesh A, Singh A, Neogi S. Tongue cleaner, an unusual foreign body in the urethra: A case report. The Australasian Medical Journal. 2013;6(10):508.\u003c/li\u003e\n \u003cli\u003eMahadevappa N, Kochhar G, Vilvapathy KS, Dharwadkar S, Kumar S. Self-inflicted foreign bodies in lower genitourinary tract in males: Our experience and review of literature. Urology annals. 2016 Jul 1;8(3):338-42.\u003c/li\u003e\n \u003cli\u003eCam B, Tuncer H, Uzun O, Uysal E. Nail scissor as a rare foreign body in the urethra: case report. Cureus. 2019 Jan;11(1).\u003c/li\u003e\n \u003cli\u003eTrehan RK, Haroon A, Memon S, Turner D. Successful removal of a telephone cable, a foreign body through the urethra into the bladder: a case report. Journal of medical case reports. 2007 Dec;1:1-3.\u003c/li\u003e\n \u003cli\u003eVan Ophoven A, de Kernion JB. Clinical management of foreign bodies of the genitourinary tract. The Journal of urology. 2000 Aug 1;164(2):274-87.\u003c/li\u003e\n \u003cli\u003eMuraveji Q, Sherzad A. Retention of a self-inserted urethral foreign body in an adolescent boy. Journal of Pediatric Surgery Case Reports. 2020 Apr 1;55:101409.\u003c/li\u003e\n \u003cli\u003eBarzilai M, Cohen I, Stein A. Sonographic detection of a foreign body in the urethra and urinary bladder. Urologia internationalis. 2000 Jun 2;64(3):178-80.\u003c/li\u003e\n \u003cli\u003eCury J, Coelho RF, Srougi M. Retroperitoneal migration of a self-inflicted ballpoint pen via the urethra. International braz j urol. 2006;32:193-5. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vesical foreign body, Urinary retention, Kat chewing, Cystoscopy","lastPublishedDoi":"10.21203/rs.3.rs-9175460/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9175460/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Although foreign bodies in the lower urinary tract are rare, several reported cases highlight their significance, with potential causes including self-insertion into the urethra, iatrogenic factors, penetrating trauma, and migration from nearby organs. Self-insertion of objects into the urinary tract is quite rare in emergency visits, but it is one of the potential causes of acute urinary retention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Report:\u003c/strong\u003e Here, we reported a 40-year-old healthy male presented to the emergency department with complaints of urinary retention and severe suprapubic pain. After a significant loss of self-awareness due to khat use, he attempted to alleviate his discomfort by inserting a foreign object. Imaging confirmed a foreign body in the bladder, identified as a coiled rubber tube via cystoscopy. Given the complexity of its configuration, open bladder surgery was required for removal. The patient responded well to treatment and was discharged after careful monitoring. The patient was recommended for psychiatric consultation and a postoperative retrograde urethrogram.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhy should an emergency physician be aware of this?\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe identification and management of such cases can pose unique challenges, as the foreign objects may assume intricate configurations within the bladder or urethra, as demonstrated by the coiled rubber tube in the present case. Comprehensive diagnostic imaging, such as contrast enhanced CT scan and cystoscopic examination performed here, is often crucial for accurately characterizing the nature and extent of the foreign body, which then informs the appropriate treatment approach. This case highlights the importance of a thorough clinical assessment and a multidisciplinary approach in managing patients with self-inserted foreign bodies in the lower genital tract, to provide effective care and prevent potential complications.\u003c/p\u003e","manuscriptTitle":"Khat-Induced Intravesical Coiling of a Self-Inserted Urethral Serum Set: A Rare Cause of Acute Urinary Retention Requiring Open Bladder Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:49:58","doi":"10.21203/rs.3.rs-9175460/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T12:51:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T05:17:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T17:59:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T22:41:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323770020058178234198420838754603638678","date":"2026-04-30T15:42:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195321574826269745956275238651947246414","date":"2026-04-29T04:28:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86146173688205202138591759350192348508","date":"2026-04-24T15:57:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T13:53:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-21T07:25:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-21T07:24:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2026-03-20T06:07:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1258b22-c0ba-484a-b556-e27e7bf296ba","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T12:51:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T05:17:41+00:00","index":29,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T17:59:01+00:00","index":28,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T22:41:06+00:00","index":27,"fulltext":""},{"type":"reviewerAgreed","content":"323770020058178234198420838754603638678","date":"2026-04-30T15:42:15+00:00","index":26,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T13:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:49:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9175460","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9175460","identity":"rs-9175460","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}