Management of foreign bodies in the urinary tract

Introduction: Foreign bodies in the urinary tract may present in various ways. These require a wide range of interventions for retrieval. In this study, we describe our experience in managing foreign bodies in the urinary tract with emphasis on clinical presentation, mechanism of insertion, investigation and treatment of these patients from a South Asian country.

Methods: A retrospective analysis of 30 foreign bodies treated by a single urological surgeon in two teaching hospitals in Sri Lanka over 20 years was performed. Data were retrieved from clinical records and follow-up visits focussing on clinical presentation, nature of foreign bodies, mechanism of insertion, investigations, management and complications.

Results: The majority were males (73.3%, n=22) with a median age of 34 years (range:14-72). The majority were self-inserted (n=14) or iatrogenic (n=10). X-rays and ultrasound scans were useful in the majority to clinch the diagnosis. The majority were retrieved endoscopically through minimally invasive approaches. Open surgeries were needed for a patient with a large bladder stone associated with a metal chain and retrieval of a retained swab. Common complications associated with foreign bodies included infections (n=9), calcification/ stone formation (n=9) and acute urinary retention (n=4). Among deliberate self- insertions, two had a low intelligent quotient and the majority had no underlying psychiatric condition needing intervention.

Conclusions: Simple investigations such as X-ray and ultrasound scans are sufficient to locate and plan interventions in the majority. Minimally invasive approaches are successful in most. The vast majority of the patients with self-insertion had no psychiatric conditions needing intervention.