A Foreign Body in The Bladder:

An Initial Case Report

Muhammad Edy Haeruddin1, Octoveryal Aslim2
1
General Practitioner, Surakarta General Hospital 2Urologist, Surakarta General Hospital

Background
Foreign bodies in the urinary bladder are relatively rare. Foreign bodies introduced through the urethra are the most common
cause of bladder foreign bodies and introduced for the purpose of sexual stimulation. Some complications may be associated with long
standing bladder foreign bodies as recurrent urinary tract infection and stone formation. Rarely, some patients may develop serious
complications such as perforation of the urinary bladder or hydronephrosis with impairment of renal function. The physical examination is
usually unremarkable. X-ray imaging detects radiopaque foreign bodies, while other foreign bodies are usually detected through
ultrasonography. The primary treatment includes careful removal of the foreign body. With advances in endoscopic techniques, open
surgery is not usually required, and the majority of cases can be treated using minimally invasive techniques.

Case Presentation
A 37 years old female patient presented to our emergency
unit complaining of dysuria, hematuria and suprapubic pain since a
week before admission after self-inserted of a sex toys made of
toothbrush inside the bladder during sexual intercourse. Physical
examination revealed suprapubic tenderness on palpation. An
ultrasound and computed tomography confirmed the presence of a
tube inside the bladder with perforation of the bladder dome. Under
regional anesthesia, visualizing cystoscopy using nephroscope was
performed and the tube was successfully extracted, minor bladder
perforation was detected. The operative time was 20 minutes with
no intraoperative complications. Eighteen Fr Foley's catheter was
inserted for 7 days to ensure complete healing of the minor bladder
dome perforations. The postoperative recovery was satisfactory.

Discussion
Nowadays, case of foreign bodies in the bladder had been Figure 1. Non Contrast MSCT Urology
increasing. Various kind of bladder foreign bodies were reported
such as pen, pencil, needle, wires, telephone cable, wooden sticks,
bullet, fish hooks, metal rods, a toothbrush and many more.
However, the presence of a toothbrush tube in the urinary bladder
was extremely rare and should treated by surgical exploration as this
may due to the size and the length of the toothbrush could
penetrate and increase the liability to perforate the bladder dome
and surrounding organs. This case was the first case in our hospital
and was the unique one. We successfully extracted the whole
toothbrush from the bladder by using a stone forceps. Our operator Figure 2. Cytoscopic view during the operative procedure
faced a bit difficulties during the procedure because of the end of the
toothbrush were penetrating into the bladder wall, so we should be
careful to extracted it and prevent further perforation. Further
consultation and examination to the psychiatrist is required.

Conclusion
The presence of foreign bodies in the bladder was a
pathological incidence that is relatively rare and could give an
impact in many case to the patients. Figure 3. A green Toothbrush Tube after being removed
from the bladder

Keywords: foreign body, toothbrush, sex toys, bladder, sexual stimulation

References:
1. Ahmed M H S, Pawar P W, Sawant S A, Sakharani J, et al. Foreign Body in Urinary Bladder: Our Experience and Review of Literature. Int Surg J. 2019 Dec;6(12):4327-4331.
2. Raheem A A, Hafez K, et al. Cystoscopic Extraction of a Whole Pen from the Bladder: A Case Report and Review of Bladder Foreign Bodies' Treatment Options. World J
Nephrol Urol and Elmer Press Inc. Vol. 3 P 54-57.
3. Odoemene CA, Onuh CA. Foreign Bodies in The Urinary Bladder-Case Series. J West African Coll Surg. 2017;7(3):124.
4. Shimokihar K, Kawahara T, Hayashi Y, Tsutsumi S, Takamoto D, Mochizuki T, Uemura H. Foreign Body in The Bladder: A Case Report. Int J Surg Case Rep. 2017;32:22-4.
5. Kesri G, Gupta P, Gupta HL, Sadasukhi TC, Dangayachi KK. An Unusual Self Inicted Foreign Body in The Urinary Bladder. IJMPCR. 2015;4:68-71.
5. Kassab, M. Y., Majid, A., Farooq, M. U., Azhary, H., Hershey, L. A., Bednarczyk, E. M., … Johnson, M. D. (2007). TCD: An Introduction for Primary Care Physicians. The Journal
of the American Board of Family Medicine, 20(1), 65–71. https://doi.org/10.3122/jabfm.2007.01.060128
6. MARINONI, M., GINANNESCHI, A., & INZITARI, D. (1989). Age Specic Normal Flow Velocity Values on TCD: Examination of the Basal Cerebral Arteries. Echocardiography,
6(4), 347–351. https://doi.org/10.1111/j.1540-8175.1989.tb00314.x
7. Naqvi, J., Yap, K. H., Ahmad, G., & Ghosh, J. (2013). TCD ultrasound: A review of the physical principles and major applications in critical care. International Journal of
Vascular Medicine, 2013(March). https://doi.org/10.1155/2013/629378