Abstract
Intra-vesical foreign bodies can be of variable nature and etiology, their introduction can be voluntary or not. The motivations most frequently associated with the presence of foreign bodies within the bladder are of a sexual or erotic nature. Various objects have been inserted into the bladder and many patients fail to remove them themselves and are very embarrassed to seek medical advice, which is the origin of a clinical picture which is most often atypical which occurs in a patient particular terrain.
1. Introduction
Intra-vesical foreign bodies can be of variable nature and etiology, their introduction can be voluntary or not. The motivations most frequently associated with the presence of foreign bodies within the bladder are of a sexual or erotic nature. Various objects have been inserted into the bladder and many patients fail to remove them themselves and are very embarrassed to seek medical advice, which is the origin of a clinical picture which is most often atypical which occurs in a patient particular terrain.
2. Case presentation
45-year-old women presented to the emergency for low urinary tract symptoms (LUTS): urgenturia evaluating since one year with neither hematuria nor urinary incontinence. No medical history was found except for being followed for mood disorders. The patient reported that she was been treated several times for cystitis but no explorations were done. Physical examination was normal. Urinalysis revealed 23–25 erythrocytes/high-power field (HPF) and full of leukocytes/HPF on microscopic examination. X-ray showed a radio-opaque shadow with rectangular form inside reminding the form of a glass. The giant stone measured 8cm × 7cm X 8cm (Fig. 1). The patient disclosed this happened while he was using an intra-vaginal foreign body (glass) for erotic perposes 4 years ago. The patient underwent surgery. Open cystolithotomy was done under general anesthesia. The stone was removed (Fig. 2). The patient was discharged on day 2 and follow up was uneventful.
Fig1 X-ray showing a radio-opaque shadow with rectangular form inside reminding the form of a glass.
Fig2: Post operative picture of the stone after removing it by open cystolithotomy.
3.Discussion
Intravesical foreign bodies represent a particular entity that generally occurs in the context of psycho-affective disorders1 or sometimes in the context of sexual assault. Voluntary introduction through the urethral meatus often reflects a particular psychopathological condition.2,3 Its relatively high frequency in women is explained by the shortness of the urethra, its contiguity with the vagina as well as its erogenous character, which can give their introduction a masturbatory character in search of erotic sensation, in addition to the ease of the gesture itself. The foreign body can migrate from a neighboring organ: intrauterine device, non-absorbable thread or other materials such as reinforcement strips in synthetic material. In our case the glass was calcified in the bladder supposing that it moved from the vagina by eroding both of the vaginal and cystic walls. The mechanisms that promote this migration could be related to local suppuration.4 The diagnosis of intra-vesical foreign body is not hard to establish. In the case of an evocative history (psychological state, history of surgery on the bladder, etc.), the radiography without preparation, ultrasound and/or cystoscopy in case of doubt allow the diagnosis to be established. Moreover, apart from any underlying psychological condition, the humiliating nature of the pathology itself often means that the diagnosis is established late at the stage of complications: recurrent urinary tract infection, bladder lithiasis, vesicovaginal fistula which is the consequence of erosion of the vesicovaginal wall weakened by inflammation. The extraction of the foreign body is usually done endoscopically with, if possible, extraction of the associated lithiasis. In case of voluminous lithiasis or in the presence of associated lesions, open surgery is indicated.5
4. Conclusion
This is an anecdotal pathological condition often occurring in a particular psychopathological profile. The mechanism of introduction is variable. Complicated forms are those diagnosed late and often associated with recurrent urinary tract infections, lithiasis and/or fistulas. The best treatment remains preventive by balancing the underlying etiopathogenic disorder and by a good sex education.
Chaabouni A, Samet A, Fourati M, Harbi H, Amine Mseddi M, Hadjslimene M. A bladder stone surrounding a foreign body: A rare case. Urol Case Rep. 2021 Nov 11;40:101943. doi: 10.1016/j.eucr.2021.101943. PMID: 34824980; PMCID: PMC8605236.
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