Self inserted foreign body in bladder of a male patient : complications and management.

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Ali Ahmad, Muhammad Usama Bin Shabbir, Abdullah Tariq, Sana Javeriya, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5194770/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We document the case of a 28-year-old male who presented with frequent UTI and lower urinary tract symptoms including haematuria resulting from a self-inflicted intravesical foreign body. The patient underwent diagnostic evaluation, including a kidney-ureter-bladder (KUB) X-ray and ultrasound (USG), which confirmed the presence and location of the foreign object within the bladder. Due to the size and positioning of the object, an open cystectomy was performed to safely remove it. Postoperative recovery was uneventful. We discharged the patient with recommendations for psychiatric evaluation to address potential underlying behavioural or psychological issues associated with self-inflicted injuries. This case reflects the need for a multidisciplinary approach in managing similar presentations, combining surgical intervention with psychological support. Figures Figure 1 Figure 2 Figure 3 Background Foreign bodies in the urinary tract, particularly within the bladder, present a unique set of challenges for urologists. These cases can occur due to self-insertion, accidental insertion, iatrogenic causes, or migration from adjacent organs. The self-insertion of foreign objects, especially among male patients, is often associated with sexual gratification, psychological conditions, or intoxication. Such behaviour can result in significant complications, including urinary tract infections (UTIs) and haematuria, as well as more severe consequences like bladder perforation or urethral trauma. Early detection and timely intervention are crucial in preventing these complications and minimizing the necessity for extensive surgical procedures.(1) The management of intravesical foreign bodies is largely determined by the type and size of the object, its location within the urinary tract, the expertise of the surgeon, and the available instruments. While many foreign bodies can be removed transurethrally with minimal surgical access, larger or calcified objects may necessitate open surgical procedures, such as cystectomy or urethrotomy. A newer technique to remove a bladder foreign body endoscopically by using an Endoloop has also been introduced nowadays. In this case, due to the size and potential complications associated with the foreign body, an open surgical approach was deemed necessary to avoid further injury to the bladder and surrounding structures.(2) Case presentation A 28-year-old male, presented to the outpatient department (OPD) on August 21, 2024, with complaints of burning micturation, suprapubic pain and lower urinary track symptoms with on and off haematuria for three days. The patient had no significant medical or surgical history and no known psychiatric illnesses. Additionally, there was no history of any similar prior incidents. Upon further inquiry, the patient disclosed that he had self-inflicted a tube inside his urethra for sexual stimulation three days prior. During the act, the tube became lodged within the urethra. Out of embarrassment and in an attempt to avoid medical intervention, the patient did not inform anyone and tried unsuccessfully to remove the object himself over the following days. As his symptoms worsened, including increased pain and difficulty in urination, he decided to seek medical help. Upon presentation, a physical examination revealed tenderness in the suprapubic region, but no palpable mass was detected. A thorough genitourinary examination was performed to assess for signs of trauma or infection. Vital signs were stable, and there were no signs of systemic infection. Ultrasound of the patient revealed a hyperechoic linear structure extending from the urethra into the bladder, consistent with a foreign body ( Image 01). The X-ray confirmed the presence of a radiopaque foreign body within the urethra and extending into the bladder, corroborating the findings of the ultrasound. ( Image 02) Depending on the patient’s symptoms and imaging results, the decision was made to proceed with immediate surgical intervention due to the risk of further complications, such as infection or damage to the urinary tract. The management strategy involved an open surgical approach due to the position and potential complications of the foreign body. The patient was informed about the nature of the procedure, potential risks, and benefits. Consent was obtained. Routine preoperative blood tests, including a complete blood count, renal function tests, and coagulation profile, were conducted and found to be within normal limits. Intravenous antibiotics were administered prophylactically to reduce the risk of postoperative infection. An open formal cystectomy was performed under general anaesthesia. A midline suprapubic incision of 2 cm an inch above pubic symphysis was made to access the bladder directly. Upon opening the bladder, a tube approximately 15 cm in length was visualized and carefully extracted( Image 03). The bladder and urethra were inspected for any additional injuries or foreign material, and none were found. The bladder was sutured closed in two layers to ensure watertight closure, and a urethral catheter was placed to facilitate postoperative bladder drainage. drain was also placed after closure of bladder and was removed after one day. The patient was monitored closely in the recovery room for any signs of bleeding, infection, or other complications. Intravenous fluids and antibiotics were continued postoperatively to prevent infection. Pain management was provided using nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids as needed. The urethral catheter was left in place for 7 days to ensure proper healing of the bladder and urethra. The patient was discharged on postoperative day 4 with oral antibiotics and analgesics, with instructions to avoid any activities that could strain the surgical site. A follow-up appointment was scheduled for one week post-discharge to assess healing and remove the urethral catheter. A psychological evaluation was recommended to address any underlying behavioural or psychiatric issues related to the self-insertion of foreign bodies. Outcome : The patient had an uneventful recovery with no postoperative complications. On follow-up, the catheter was successfully removed, and the patient was voiding well without any symptoms. The psychological assessment revealed no underlying psychiatric disorders; however, the patient was counselled on the risks associated with self-insertion of foreign objects and the importance of seeking timely medical intervention for any future issues. Discussion The occurrence of foreign objects in the urogenital tract is an uncommon pathological condition, yet it poses significant challenges for urologists in both diagnosis and management. Self-insertion, idiopathic reasons, or migration from neighbouring organs are all possible causes of intravenous foreign bodies. Interestingly, things that are put into the urethra account for around 60% of the foreign materials that end up in the bladder.(3) According to Nazir A. et al., urethral self-placement of foreign objects in adults is often associated with erotic stimulation or mental impairment. Curiosity and inquisitiveness are the most common motivations for children to insert foreign bodies into their urethra.(4) Intoxication, mental disorientation, borderline personality disorder, schizoid personality disorder, and sexual curiosity are some mental health problems that may be linked to self-insertion of foreign items into the urethra. In such cases, patients often experience feelings of embarrassment and humiliation, leading to a delay in seeking medical attention. Some people may try to remove foreign items on their own, which can cause further migration and harm to the genitourinary tract. Clinically, patients can present asymptomatically or develop acute cystitis due to inflammation of the lower genitourinary tract. Symptoms of this irritation may include dysuria, urine frequency, lower abdomen pain, microscopic or extensive haematuria, acute urinary retention, urethral discharge, strangulation, and fever. Patients typically experience stress and pain accompanied by these symptoms.(5) The delayed presentation of foreign bodies within the urinary bladder might greatly complicate the treatment approach due to the appearance of secondary problems. These complications may include the formation of bladder stones, cystitis, bladder wall hypertrophy caused by chronic obstruction, hydronephrosis, reduced renal function, and, in severe cases, perforation of the bladder wall, as stated by Warraich, H. S. A. et al. In a case study of a teenage female who self-induced a foreign body in the urine bladder.(6) To accurately identify and localize foreign entities within the urinary bladder, imaging techniques such as ultrasound, X-rays, CT scans, and MRI are used. In some circumstances as in the case report given by Bilim . et al, cystoscopy serves as both a diagnostic and therapeutic tool, allowing direct visualization and potential extraction of the foreign bodies. (7) A full patient history and a thorough physical examination can help to make an accurate diagnosis. Attempts to catheterize or remove foreign bodies should only be performed after ascertaining the exact properties, shape, and position of the object. This method is especially important for objects located distal to the urogenital diaphragm, where direct palpation is not possible. A KUB radiograph can confirm the presence of radiopaque foreign bodies, although ultrasonography is preferred for detecting radiolucent things.(8) If it is decided that the foreign item can be removed without causing urethral injury, the endoscopic procedure should be tried first. Endoscopic treatments are commonly utilized in urology to remove foreign bodies from the bladder, utilizing a cystoscope to provide visualization and enable accurate removal with equipment such as baskets, forceps, clamshells, and grasping tools. While cystoscopic extraction is generally effective, success rates can vary between 50% and 90%. However, if the foreign body has become calcified over time or is too large, endoscopic removal may not be feasible, necessitating an open surgical procedure. For objects stuck in the penile urethra, an external urethrotomy may be required, as well as a suprapubic cystectomy for intravesical foreign bodies. Females often remove foreign bodies in the bladder endoscopically due to easier access through the urethra; however, larger or sharper objects may require open surgical removal.(9) Rafique et al. reported that cystoscopic retrieval was successful in over half of the patients.(10) Bansal et al. reported a higher success rate of endoscopic retrieval at 67%. Other interventions may include suprapubic cystolitholapaxy and cystostomy.(11) Given the high prevalence of psychiatric problems, intellectual impairments, and dementia seen in this patient population, routine psychiatric examination is recommended. However, this approach is not uniformly adopted across all healthcare practices. Take home message This case illustrates the challenges of managing self-inflicted foreign bodies in the urogenital tract, highlighting the need for accurate diagnosis, timely intervention, and psychiatric assessment. While the bladder is commonly affected and most objects can be removed transurethrally, the management strategy must be tailored to the specific circumstances, including the foreign body’s nature, location, and available resources. Declarations Author Contributions: A.A and M.U.B.S did the data collection and other works. A.T and S.J did the writing part of the case report. K.K is the corresponding author. Ethical Statement: No ERB was required for this case report but consent was obtained from the patient and that will be given upon request. Funding: No funding was obtained for this research. Acknowledgement: None. Clinical Trial Number: Clinical Trial Number in the manuscript. If not applicable, please state following in the manuscript: ‘Clinical trial number: not applicable. References Saputra HM, Kloping YP, Renaldo J, Hakim L. An earphone wire inside the urinary bladder: A case report and comprehensive literature review of genitourinary polyembolokoilamania. Radiol case Rep. 2022;17(5):1457–63. https://doi.org/10.1016/j.radcr.2022.01.080 . Al-Zubaidi M, McCombie S, Bangash H, Hayne D. A novel technique to remove a urinary bladder foreign body endoscopically using an Endoloop. Urol case Rep. 2021;40:101899. https://doi.org/10.1016/j.eucr.2021.101899 . Singh I. Intravesical Cu-T emigration: an atypical and infrequent cause of vesical calculus. Int Urol Nephrol. 2007;39(2):457–9. 10.1007/s11255-006-9021-9 . Nazir A, Runyon LC, Chowdhary S. FROM URETHRA WITH SHOVE. J Am Geriatr Soc. 2006;54(9):1477–8. Van Ophoven A, deKernion JB. Clinical management of foreign bodies of the genitourinary tract. J Urol. 2000;164(2):274–87. 10.1097/00005392-200008000-00003 . Warraich HSA, Younis Z, Warraich J, Shaukat Ali A, Warraich K. A Self-Induced Foreign Body in the Urinary Bladder of an Adolescent Female. Cureus. 2024;16(6):e61811. https://doi.org/10.7759/cureus.61811 . Megalourethra, Watanabe N, Arai S, Hoshi S. Clin Case Rep. 2023;11:0. https:// pubmed.ncbi.nlm.nih.gov/19101894 Aljarbou A, Abdo AJ, Almosa MA, Hariri A. Extraction of foreign body from the urinary bladder using nephroscope: A case report of endoscopy treatment. Urol annals. 2023;15(1):95–7. https://doi.org/10.4103/ua.ua_109_22 . https:// journals.sbmu.ac.ir/urolj/index.php/uj/article/view/28/27 Bansal A, Yadav P, Kumar M, Sankhwar S, Purkait B, Jhanwar A, Singh S. Foreign Bodies in the Urinary Bladder and Their Management: A Single-Centre Experience From North India. Int Neurourol J. 2016;20(3):260–9. https://doi.org/10.5213/inj.1632524.262 . Take home message. This case illustrates the challenges of managing self-inflicted foreign bodies in the urogenital tract, highlighting the need for accurate diagnosis, timely intervention, and psychiatric assessment. While the bladder is commonly affected and most objects can be removed transurethrally, the management strategy must be tailored to the specific circumstances, including the foreign body’s nature, location, and available resources. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5194770","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":366404729,"identity":"7b6134ca-2327-4233-82ab-b71f2ff89fa8","order_by":0,"name":"Ali Ahmad","email":"","orcid":"","institution":"Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Ahmad","suffix":""},{"id":366404733,"identity":"5d7ec6a1-3b00-433e-b989-924eda96c0fe","order_by":1,"name":"Muhammad Usama Bin 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20:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5194770/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5194770/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67292515,"identity":"1d456dfb-baab-4356-914d-0b1ec428b9a0","added_by":"auto","created_at":"2024-10-23 10:30:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":290149,"visible":true,"origin":"","legend":"\u003cp\u003eUSG KUB of the foreign body showing hyeprechoic linear structure\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5194770/v1/7cfd578dc64f97fe73b0d9ec.png"},{"id":67292513,"identity":"eda820ce-4874-4777-8ec5-c6ef26cc8579","added_by":"auto","created_at":"2024-10-23 10:30:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":409832,"visible":true,"origin":"","legend":"\u003cp\u003eXray KUB of the foreign body\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5194770/v1/a4a133a1dad39e17b037f0b3.png"},{"id":67293924,"identity":"3413e6ab-9359-486d-afd2-d31e3ae6c1c2","added_by":"auto","created_at":"2024-10-23 10:38:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":687170,"visible":true,"origin":"","legend":"\u003cp\u003eForeign body removed from the patient\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5194770/v1/94a236ad1ff2ac7e947006b7.png"},{"id":67798167,"identity":"30eb14f5-e57a-4a3a-9958-4faf9839a3c1","added_by":"auto","created_at":"2024-10-29 21:16:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2023077,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5194770/v1/fdb6f6b6-1198-41b2-960d-5ff97ed8f864.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSelf inserted foreign body in bladder of a male patient : complications and management.\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eForeign bodies in the urinary tract, particularly within the bladder, present a unique set of challenges for urologists. These cases can occur due to self-insertion, accidental insertion, iatrogenic causes, or migration from adjacent organs. The self-insertion of foreign objects, especially among male patients, is often associated with sexual gratification, psychological conditions, or intoxication. Such behaviour can result in significant complications, including urinary tract infections (UTIs) and haematuria, as well as more severe consequences like bladder perforation or urethral trauma. Early detection and timely intervention are crucial in preventing these complications and minimizing the necessity for extensive surgical procedures.(1)\u003c/p\u003e\n\u003cp\u003eThe management of intravesical foreign bodies is largely determined by the type and size of the object, its location within the urinary tract, the expertise of the surgeon, and the available instruments. While many foreign bodies can be removed transurethrally \u0026nbsp;with minimal surgical access, larger or calcified objects may necessitate open surgical procedures, such as cystectomy or urethrotomy. A newer technique to remove a bladder foreign body endoscopically by using an Endoloop has also been introduced nowadays. In this case, due to the size and potential complications associated with the foreign body, an open surgical approach was deemed necessary to avoid further injury to the bladder and surrounding structures.(2)\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 28-year-old male, presented to the outpatient department (OPD) on August 21, 2024, with complaints of burning micturation, suprapubic pain and lower urinary track symptoms with on and off haematuria \u0026nbsp;for three days. The patient had no significant medical or surgical history and no known psychiatric illnesses. Additionally, there was no history of any similar prior incidents.\u003c/p\u003e\n\u003cp\u003eUpon further inquiry, the patient disclosed that he had self-inflicted \u0026nbsp;a tube inside his urethra for sexual stimulation three days prior. During the act, the tube became lodged within the urethra. Out of embarrassment and in an attempt to avoid medical intervention, the patient did not inform anyone and tried unsuccessfully to remove the object himself over the following days. As his symptoms worsened, including increased pain and difficulty in urination, he decided to seek medical help.\u003c/p\u003e\n\u003cp\u003eUpon presentation, a physical examination revealed tenderness in the suprapubic region, but no palpable mass was detected. A thorough genitourinary examination was performed to assess for signs of trauma or infection. Vital signs were stable, and there were no signs of systemic infection. Ultrasound of the patient revealed a hyperechoic linear structure extending from the urethra into the bladder, consistent with a foreign body ( Image 01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe \u0026nbsp;X-ray confirmed the presence of a radiopaque foreign body within the urethra and extending into the bladder, corroborating the findings of the ultrasound. ( Image 02)\u003c/p\u003e\n\u003cp\u003eDepending on the patient\u0026rsquo;s symptoms and imaging results, the decision was made to proceed with immediate surgical intervention due to the risk of further complications, such as infection or damage to the urinary tract.\u003c/p\u003e\n\u003cp\u003eThe management strategy involved an open surgical approach due to the position and potential complications of the foreign body. The patient was informed about the nature of the procedure, potential risks, and benefits. Consent was obtained. Routine preoperative blood tests, including a complete blood count, renal function tests, and coagulation profile, were conducted and found to be within normal limits. Intravenous antibiotics were administered prophylactically to reduce the risk of postoperative infection.\u003c/p\u003e\n\u003cp\u003eAn open formal cystectomy was performed under general anaesthesia. A midline suprapubic incision of 2 cm an inch above pubic symphysis was made to access the bladder directly. \u0026nbsp;Upon opening the bladder, a tube approximately 15 cm in length was visualized and carefully extracted( Image 03). \u0026nbsp;The bladder and urethra were inspected for any additional injuries or foreign material, and none were found. The bladder was sutured closed in two layers to ensure watertight closure, and a urethral catheter was placed to facilitate postoperative bladder drainage. drain was also placed after closure of bladder and was removed after one day. The patient was monitored closely in the recovery room for any signs of bleeding, infection, or other complications. Intravenous fluids and antibiotics were continued postoperatively to prevent infection. Pain management was provided using nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids as needed.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The urethral catheter was left in place for 7 days to ensure proper healing of the bladder and urethra. The patient was discharged on postoperative day 4 with oral antibiotics and analgesics, with instructions to avoid any activities that could strain the surgical site. A follow-up appointment was scheduled for one week post-discharge to assess healing and remove the urethral catheter. A psychological evaluation was recommended to address any underlying behavioural or psychiatric issues related to the self-insertion of foreign bodies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e: The patient had an uneventful recovery with no postoperative complications. On follow-up, the catheter was successfully removed, and the patient was voiding well without any symptoms. The psychological assessment revealed no underlying psychiatric disorders; however, the patient was counselled on the risks associated with self-insertion of foreign objects and the importance of seeking timely medical intervention for any future issues.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe occurrence of foreign objects in the urogenital tract is an uncommon pathological condition, yet it poses significant challenges for urologists in both diagnosis and management. Self-insertion, idiopathic reasons, or migration from neighbouring organs are all possible causes of intravenous foreign bodies. Interestingly, things that are put into the urethra account for around 60% of the foreign materials that end up in the bladder.(3)\u003c/p\u003e\n\u003cp\u003eAccording to Nazir A. et al., urethral self-placement of foreign objects in adults is often associated with erotic stimulation or mental impairment. Curiosity and inquisitiveness are the most common motivations for children to insert foreign bodies into their urethra.(4)\u003c/p\u003e\n\u003cp\u003eIntoxication, mental disorientation, borderline personality disorder, schizoid personality disorder, and sexual curiosity are some mental health problems that may be linked to self-insertion of foreign items into the urethra. In such cases, patients often experience feelings of embarrassment and humiliation, leading to a delay in seeking medical attention. Some people may try to remove foreign items on their own, which can cause further migration and harm to the genitourinary tract.\u003c/p\u003e\n\u003cp\u003eClinically, patients can present asymptomatically or develop acute cystitis due to inflammation of the lower genitourinary tract. Symptoms of this irritation may include dysuria, urine frequency, lower abdomen pain, microscopic or extensive haematuria, acute urinary retention, urethral discharge, strangulation, and fever. Patients typically experience stress and pain accompanied by these symptoms.(5)\u003c/p\u003e\n\u003cp\u003eThe delayed presentation of foreign bodies within the urinary bladder might greatly complicate the treatment approach due to the appearance of secondary problems. These complications may include the formation of bladder stones, cystitis, bladder wall hypertrophy caused by chronic obstruction, hydronephrosis, reduced renal function, and, in severe cases, perforation of the bladder wall, as stated by Warraich, H. S. A. et al. In a case study of a teenage female who self-induced a foreign body in the urine bladder.(6)\u003c/p\u003e\n\u003cp\u003eTo accurately identify and localize foreign entities within the urinary bladder, imaging techniques such as ultrasound, X-rays, CT scans, and MRI are used. In\u0026nbsp;\u0026nbsp;some circumstances as in the case report given by Bilim . et al, cystoscopy serves as both a diagnostic and therapeutic tool, allowing direct visualization and potential extraction of the foreign bodies. (7)\u003c/p\u003e\n\u003cp\u003eA full patient history and a thorough physical examination can help to make an accurate diagnosis. Attempts to catheterize or remove foreign bodies should only be performed after ascertaining the exact properties, shape, and position of the object. This method is especially important for objects located distal to the urogenital diaphragm, where direct palpation is not possible. A KUB radiograph can confirm the presence of radiopaque foreign bodies, although ultrasonography is preferred for detecting radiolucent things.(8)\u003c/p\u003e\n\u003cp\u003eIf it is decided that the foreign item can be removed without causing urethral injury, the endoscopic procedure should be tried first. Endoscopic treatments are commonly utilized in urology to remove foreign bodies from the bladder, utilizing a cystoscope to provide visualization and enable accurate removal with equipment such as baskets, forceps, clamshells, and grasping tools. While cystoscopic extraction is generally effective, success rates can vary between 50% and 90%. However, if the foreign body has become calcified over time or is too large, endoscopic removal may not be feasible, necessitating an open surgical procedure. For objects stuck in the penile urethra, an external urethrotomy may be required, as well as a suprapubic cystectomy for intravesical foreign bodies. Females often remove foreign bodies in the bladder endoscopically due to easier access through the urethra; however, larger or sharper objects may require open surgical removal.(9) \u0026nbsp; Rafique et al. reported that cystoscopic retrieval was successful in over half of the patients.(10) Bansal et al. reported a higher success rate of endoscopic retrieval at 67%. Other interventions may include suprapubic cystolitholapaxy and cystostomy.(11)\u003c/p\u003e\n\u003cp\u003eGiven the high prevalence of psychiatric problems, intellectual impairments, and dementia seen in this patient population, routine psychiatric examination is recommended. However, this approach is not uniformly adopted across all healthcare practices.\u003c/p\u003e"},{"header":"Take home message","content":"\u003cp\u003eThis case illustrates the challenges of managing self-inflicted foreign bodies in the urogenital tract, highlighting the need for accurate diagnosis, timely intervention, and psychiatric assessment. While the bladder is commonly affected and most objects can be removed transurethrally, the management strategy must be tailored to the specific circumstances, including the foreign body\u0026rsquo;s nature, location, and available resources.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.A and M.U.B.S did the data collection and other works. \u0026nbsp; A.T and S.J did the writing part of the case report. K.K is the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Statement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo ERB was required for this case report but consent was obtained \u0026nbsp;from the patient and that will be given upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical Trial Number:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical Trial Number in the manuscript. If not applicable, please state\u003c/p\u003e\n\u003cp\u003efollowing in the manuscript: \u0026lsquo;Clinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaputra HM, Kloping YP, Renaldo J, Hakim L. An earphone wire inside the urinary bladder: A case report and comprehensive literature review of genitourinary polyembolokoilamania. Radiol case Rep. 2022;17(5):1457\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.radcr.2022.01.080\u003c/span\u003e\u003cspan address=\"10.1016/j.radcr.2022.01.080\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Zubaidi M, McCombie S, Bangash H, Hayne D. A novel technique to remove a urinary bladder foreign body endoscopically using an Endoloop. Urol case Rep. 2021;40:101899. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.eucr.2021.101899\u003c/span\u003e\u003cspan address=\"10.1016/j.eucr.2021.101899\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh I. Intravesical Cu-T emigration: an atypical and infrequent cause of vesical calculus. Int Urol Nephrol. 2007;39(2):457\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11255-006-9021-9\u003c/span\u003e\u003cspan address=\"10.1007/s11255-006-9021-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNazir A, Runyon LC, Chowdhary S. FROM URETHRA WITH SHOVE. J Am Geriatr Soc. 2006;54(9):1477\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Ophoven A, deKernion JB. Clinical management of foreign bodies of the genitourinary tract. J Urol. 2000;164(2):274\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00005392-200008000-00003\u003c/span\u003e\u003cspan address=\"10.1097/00005392-200008000-00003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarraich HSA, Younis Z, Warraich J, Shaukat Ali A, Warraich K. A Self-Induced Foreign Body in the Urinary Bladder of an Adolescent Female. Cureus. 2024;16(6):e61811. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.61811\u003c/span\u003e\u003cspan address=\"10.7759/cureus.61811\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMegalourethra, Watanabe N, Arai S, Hoshi S. Clin Case Rep. 2023;11:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ehttps://\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epubmed.ncbi.nlm.nih.gov/19101894\u003c/span\u003e\u003cspan address=\"http://pubmed.ncbi.nlm.nih.gov/19101894\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAljarbou A, Abdo AJ, Almosa MA, Hariri A. Extraction of foreign body from the urinary bladder using nephroscope: A case report of endoscopy treatment. Urol annals. 2023;15(1):95\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/ua.ua_109_22\u003c/span\u003e\u003cspan address=\"10.4103/ua.ua_109_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ehttps://\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ejournals.sbmu.ac.ir/urolj/index.php/uj/article/view/28/27\u003c/span\u003e\u003cspan address=\"http://journals.sbmu.ac.ir/urolj/index.php/uj/article/view/28/27\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBansal A, Yadav P, Kumar M, Sankhwar S, Purkait B, Jhanwar A, Singh S. Foreign Bodies in the Urinary Bladder and Their Management: A Single-Centre Experience From North India. Int Neurourol J. 2016;20(3):260\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5213/inj.1632524.262\u003c/span\u003e\u003cspan address=\"10.5213/inj.1632524.262\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTake home message. This case illustrates the challenges of managing self-inflicted foreign bodies in the urogenital tract, highlighting the need for accurate diagnosis, timely intervention, and psychiatric assessment. While the bladder is commonly affected and most objects can be removed transurethrally, the management strategy must be tailored to the specific circumstances, including the foreign body\u0026rsquo;s nature, location, and available resources.\u003c/span\u003e\u003c/li\u003e\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":"","lastPublishedDoi":"10.21203/rs.3.rs-5194770/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5194770/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe document the case of a 28-year-old male who presented with frequent UTI and lower urinary tract symptoms including haematuria resulting from a self-inflicted intravesical foreign body. The patient underwent diagnostic evaluation, including a kidney-ureter-bladder (KUB) X-ray and ultrasound (USG), which confirmed the presence and location of the foreign object within the bladder. Due to the size and positioning of the object, an open cystectomy was performed to safely remove it. Postoperative recovery was uneventful. We discharged the patient with recommendations for psychiatric evaluation to address potential underlying behavioural or psychological issues associated with self-inflicted injuries. This case reflects the need for a multidisciplinary approach in managing similar presentations, combining surgical intervention with psychological support.\u003c/p\u003e","manuscriptTitle":"Self inserted foreign body in bladder of a male patient : complications and management.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-23 10:30:37","doi":"10.21203/rs.3.rs-5194770/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":"7b65b004-4989-4cf5-a64f-14074503922b","owner":[],"postedDate":"October 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-29T21:08:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-23 10:30:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5194770","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5194770","identity":"rs-5194770","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}