Foreign bodies in upper urinary tract are relatively rare and mainly caused by iatrogenic injuries while the etiologies of foreign bodies in lower urinary tract are multiple i.e., self-insertion for sexual gratification, iatrogenic, accidental, trauma and migration from adjacent structures [6, 7]. In literature, various iatrogenic objects reported in bladder i.e., catheter tips, parts of catheter balloons, forgotten DJ stent with encrustations, buggies, beaks of resectoscope sheaths while Self-Inflicted foreign bodies reported are crystal glass stirrers, copper wire, metallic cables, lead pencil and ball pen [8]. Psychological aspects like mental illness, exotic impulse and personality disorders should be considered in patients with self-insertion of foreign bodies [9].
Most patients have LUTS and present early while few have mild or no symptoms and present late with complications like bladder stone, oliguria, renal failure or bladder fistulas. Symptoms caused by intravesical foreign bodies are frequency, urgency, dysuria, suprapubic pain, hematuria, strangury, poor urinary stream and urinary retention [10, 11]. Our patient present late with complication of renal failure.
Diagnosis of intravesical foreign body is relatively easy and simple plain radiograph of abdomen can confirm radiopaque foreign body and bladder stone. Ultrasound KUB is sufficient for radiolucent stones and to demonstrate proximal hydronephrosis while CT KUB needed in some cases to measure the exact size of bladder stone formed on foreign body and to plan surgery like in our case. Cystoscopy is the definitive diagnostic procedure for diagnosis of intravesical foreign body.
The aim of treatment should be to remove the foreign body and to avoid the complications. The method of removal of foreign body should be selected on the basis of shape, size, nature and mobility of foreign body. Endoscopic treatment should be attempted first as minimal trauma to patient [12]. In literature some cases of removal of foreign bodies by percutaneous or laparoscopic approach are reported to minimize the risk of open surgery [13, 14]. Open surgery is indicated for large or sharp foreign bodies and in cases of failed endoscopic attempt. In our case, open vesicolithotomy was done as bladder stone was very large.
Iatrogenic foreign bodies are mostly soft now a days and usually present early while self- inserted are hard or dangerous and mostly present late with complications due to embarrassment. Psychiatric evaluation of these patients needed as some of these patients may be suffering from autoeroticism or sexual addiction and objects inserted for these purposes may be dangerous which can lead to life threatening complications [15].