Sexually Transmitted Diseases - I. I. Mavrov 2005

Diseases of the genital organs of various etiologies
Foreign bodies in the urethra

Foreign bodies enter the Urethra through the external urethral meatus, and less frequently from the Urinary Bladder. The pathways of their entry are highly diverse: they may be left behind following therapeutic manipulations (catheters, elastic bougies, cotton swabs, etc.); after surgical and reconstructive Procedures on the urethra; they may penetrate from surrounding Tissues via urethral wall perforation or open trauma (needles, pins, bone sequestra, etc.); or As a result of masturbation or behavioral acts in psychiatric patients.

Drainage fragments and ligatures originating from Operations on the Kidney, renal pelvis, and Ureter, as well as bone sequestra and endoparasites that have perforated the bladder wall, can enter the urethra from the urinary bladder.

In men, foreign bodies are most commonly lodged in the navicular fossa, prostatic, and bulbar segments of the urethra. In women, foreign bodies are rarely retained or incarcerated in the urethra; they typically pass directly into the urinary bladder.

In boys, foreign bodies easily become trapped in the navicular fossa or the bulbar urethra, and less frequently in the posterior urethra, from where they usually migrate into the urinary bladder. In girls, foreign bodies generally do not remain in the urethra, but are either expelled outwardly or settle in the bladder.

Foreign bodies that have entered the urethra may migrate toward the bladder or remain fixed at the site of penetration, undergoing various changes and either partially or completely obstructing the urethral lumen.

The Clinical presentation depends on the shape, size, and duration of the foreign body's presence in the urethra. Most commonly, patients complain of dull or constant sharp pain, or pain occurring during urination or erection.

Urinary disorders typically do not appear immediately after a foreign body enters the urethra (except in cases where it significantly narrows the urethral lumen). Only after a few days, when urethral mucosal edema develops, does urination become painful and difficult, with urine passing in a thin or interrupted stream. Complete urinary retention is occasionally observed. Minor bleeding or massive urethral Hemorrhage may occur. With the onset of infection, urinary frequency increases. In some cases, Urinary Incontinence or involuntary urination, as well as mucopurulent or bloody-purulent discharge, are noted. Sometimes inflammation of the Penis, Prostate Gland, and urinary bladder develops. Frequently, a foreign body residing in the urethra becomes encrusted with salts and serves as a nidus for stone formation.

The Diagnosis is established based on the Clinical Presentation and medical history. When a foreign body is suspected, its Location, size, and shape are determined. In men, it is easily palpable in the pendulous urethra, and in the prostatic urethra via digital rectal examination. In women, the urethra is palpated vaginally. To refine the diagnosis, urethral sounding with a bougie or metal catheter, urethroscopy, plain radiography, urethrography, and ultrasound are performed.

Treatment. A foreign body in the pendulous urethra is extracted using a Volkmann spoon, urethral forceps, or tweezers. If the foreign body is located in the posterior urethra, it is most often pushed into the urinary bladder using a metal bougie and retrieved via endovesical instruments or cystostomy. In rare cases (such as penetration into the urethral mucosa or incarceration of the foreign body), urethrotomy is employed.

Foreign bodies enter the urinary bladder relatively often in adults and rarely in children. The routes of their entry into the bladder are highly varied: therapeutic and diagnostic procedures, bladder surgeries, masturbation, and psychiatric manifestations.

In A number of cases, the exact cause of a foreign body entering the urinary bladder cannot be determined. Typically, it enters the bladder through the urethra, and less commonly from the ureter or through the bladder wall from surrounding tissues. Various objects are found in the urinary bladder: pins, pieces of wire, pencils, wax candles, thermometers, Glass shards, gauze Sponges, catheter tips, and rubber or elastic catheters, etc.

The clinical picture is characterized by diverse symptoms. Foreign bodies induce an inflammatory process in the urinary bladder that generally involves the bladder wall and clinically manifests as cystitis. Patients suffer from dysuria, urinary hesitancy, pain upon movement, and Hematuria. If a foreign body is positioned partly in the urinary bladder and partly in the posterior urethra, the patient experiences urinary incontinence or retention.

The diagnosis of foreign bodies in the urinary bladder is generally straightforward. It is established on The basis of the medical history, cystoscopy, and radiological and ultrasound examinations, which serve as the primary Methods for identifying foreign bodies in the bladder.

Treatment. Any foreign body must be removed from the urinary bladder. Removal of foreign bodies is performed either endovesically or surgically.