The Wooden Rod Foreign Body in the Urethra after Self-Dilatation of the Urethral Stricture: Case Report in the National Hospital of Ignace Deen Conakry (Guinea) ()
1. Introduction
Self-insertion of a foreign body into the urethra is a rare condition, it is often reported in the literature as isolated cases [1]. This condition may arise as a result of satisfaction of erotic curiosity, mental disorders, or rarely in the context of an attempt to evacuate urine during acute urinary retention [2]. Several types of foreign bodies have been described in the literature. The diagnosis is most often clinical and management is generally endoscopic [3].
Although it is more common in patients with mental disorders, it has also been described in people in full possession of all their mental abilities. We report through this clinical case a situation of self-insertion of a wooden rod in an 80-year-old patient, presenting with meatal stenosis without any associated mental deficit. Through this case, we underscore the lack of information on urology in the general population and the socio-cultural considerations making urological pathologies taboo subjects.
2. Observation
We had an 80-year-old patient, retired, residing in Gbessia port 1 located in the region of Conakry, who was admitted with complaint of acute urinary retention secondary to urethral outlet obstruction occurring 2 hours after self-insertion of a wooden rod into the urethra. History taking revealed a relevant past history of purulent urethritis, hypertension and self-dilatation of the urethra using rigid objects (wooden rods, etc.). There was no psychiatry past history.
Physical examination revealed a satisfactory general condition, normal-colored skin and conjunctivae, BP = 150/90 mmhg.
A palpable and mildly tender bladder globe, stenosis of the urethral meatus, induration along the anterior urethra from the navicular fossa to the root of the anterior third of the penis (Figure 1). The perineum was physically normal. On digital rectal examination, the prostate was slightly enlarged, smooth, elastic, painless and well limited.
An antero-posterior x-ray of the pelvis with penile centering did not allow for visualization of the foreign body.
Urea and creatinin were normal.
The patient underwent urine drainage by transvesical catheter and meatoplasty associated with the removal of a wooden rod of about 4 cm (Figure 2). The urethral catheter was put to replace the cystostomy for one week, after the removal of the catheter the patient had a very good urine flow.
We reviewed the patient 6 months after meatoplasty with normal urine flow. Urine analysis and culture results were normal.
3. Discussion
Most urinary tract foreign bodies are inserted during masturbation. This is however usually in the context of mental illness with self-aggressive impulsive acts [4].
Patients who are sometimes in full possession of their mental abilities use makeshift instruments for self-dilatation of the urethra. These instruments can remain or fragment in the urethra causing hemorrhagic, obstructive or infectious complications. Dysuria or urinary retention is the revealing symptoms of foreign bodies in the urethra [5]. The clinical and paraclinical diagnosis is based on history taking (notion of introduction of a foreign body into the urethra), physical examination (palpation of the foreign body along the urethra), radiography, computed tomography [3].
In our case, the diagnosis was purely clinical with palpation of the rod along the urethra. Antero-posterior pelvic X-ray didn’t help for the diagnosis. Computed tomography was not done in this case.
Differential diagnosis with other urinary tract diseases can be difficult when patients do not admit that a foreign body has been self-inserted as could be the case in the event of mental illness or in the absence of a previous history of self-insertion foreign body [6]. Most foreign bodies from the urethra are removed by minimally invasive endoscopic techniques [1], and any manipulation or urethral catheterization should be prohibited until the exact type, shape, size, mobility and location of the object are determined. In some complex cases, such as that of our patient (anatomical abnormality of the associated urethra, calcified foreign body) [7] [8], surgery is certainly more invasive, but has the advantage of solving the problem without great morbidity. The foreign bodies are very varied, wooden rod as in the case of our patient, but also electric cables, tweezers, hairpins, pushpins, pebbles, paper clips [6].
4. Conclusion
The self-insertion of foreign bodies into the urethra in patients in full possession of their mental faculties with urethral stenosis is carried out for the purpose of self-dilatation of the urethra. Treatment must systematically have two components, on one hand, the extraction of the foreign body and on the other hand the correction of the stenosis.