Self-inflicted male urethral foreign body insertion: Endoscopic management and complications

OBJECTIVE: To evaluate the cause, diagnosis, management and complications of self-inserted urethral foreign bodies in men, reviewing a 17-year experience. PATIENTS AND METHODS: From November 1986 to January 2004, 17 men were treated for self-inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications. RESULTS: In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton-tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body. CONCLUSION: Self-inflicted urethral foreign-body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow-up, albeit difficult in these patients, is desirable.