Multiple cases of foreign objects inserted into the urethra have been described. Nonetheless, It is a relatively rare occurrence. These foreign objects are typically inserted due to psychiatric illness, intoxication, or autoeroticism. Polyembolokoilamania is the insertion of foreign objects into body orifices for sexual gratification.Removal of the foreign object may present a challenge depending on the size, shape and location. These objects can cause pain, hematuria, and trauma to the urethra ultimately leading to urethral stricture disease. We present the case of a male patient who inserted a long straw into his urethra for sexual gratification and inadvertently injected spray foam insulation into the full length of his urethra filling his bladder.
Case report:
A 45-year-old male patient presented to the emergency department with hematuria and difficulty with urination. He had been inserting various objects into his urethra as an aid for erectile dysfunction. His partner had inserted a straw attached to a can of weatherproofing spray foam into his urethra three weeks prior and inadvertently pressed the button deploying the foam. Since then, he had progressively worsening difficulty with urination, dysuria, and gross hematuria with urinary retention. Computed tomography (CT) of the abdomen and pelvis showed radiolucent foreign material in the nondependent bladder measuring 10.7 × 4.3 × 6 cm. There was additional radiolucent foreign material noted in the penis measuring up to 16mm in width.
Fig. 1. CT Scan: Arrows point to spray foam within the urinary tract.
After obtaining informed consent, the patient was taken to the operating room for removal of the foreign body. He underwent open cystotomy with removal of foreign body, cystourethroscopy, urethral dilation, perineal urethrotomy and closure of perineal urethrotomy. The spray foam was removed from the bladder and prostatic urethra first through a cystotomy. An attempt was made to remove the spray foam in the urethra endoscopically in an antegrade fashion from the cystotomy using a basket, however the patient had urethral stricture disease and the narrow portions of his urethra anchored the spray foam in place. Ultimately a perineal urethrostomy was required to remove the remaining fragments (Fig. 2). Intraoperative findings showed multiple anterior urethral strictures, however, an approximately 10 French midshaft urethral stricture limited the passage of the cystoscope. A 20-french suprapubic tube, 14-french urethral catheter, and pelvic drain were ultimately placed. The postoperative course was unremarkable with a retrograde urethrogram at three weeks showing no contrast extravasation from the urethra. The drain and urethral catheter were removed and the patient has been managed subsequently with a suprapubic tube in anticipation of a urethral repair.
Rosa Park, Susan M. MacDonald,
Urinary tract foreign body: A case of panurethral and intravesical spray foam insulation,
Urology Case Reports,
Volume 33,
2020,
101363,
ISSN 2214-4420
Abstract: Foreign bodies are inserted into the genitourinary tract for various reasons, and may present a challenge to remove. We report a case of foam insulation injected into the urethra almost entirely occluding the urethra and filling the bladder. Ultimately both a cystotomy and perineal urethrotomy were required for removal.
Keywords: Urethra; Foreign body; Urethral stricture; Polyembolokoilamania; Urethrotomy
Division of Urology, Northport VA Medical Center, Northport, NY, USA
Division of Urology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Hershey, PA, USA