Self-Insertion of Newspaper into Bladder: An Unusual Case of Foreign Body

By Mustafa Erkoc¹, Yusuf Turushan Ozcanli², Murat Burak Keskin², Nusret Ayaz³

Affiliations

1. Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
2. Department of Urology, Beylikduzu State Hospital, Istanbul, Turkey
3. Department of Forensic Medicine, Nigde Training and Research Hospital, Nigde, Turkey

doi: 10.29271/jcpsp.2022.Supp.S98

ABSTRACT
Foreign bodies are most frequently observed in the bladder among the genitourinary organs. Many different foreign bodies such as needles, wires, Foley’s catheter fragments, and magnetic balls have been observed in the bladder previously. In the present case, a 50-year male patient presented to the hospital with fever and acute urinary retention. Despite antibiotic therapy, the urinary tract infection did not regress, and the patient's suspicious statements were associated with the foreign body. Examination of the patient necessitated further enquiry upon the detection of newspaper pieces in the bladder. It was discovered that the patient had folded the newspaper in an attempt to commit suicide and pushed it into the bladder. Such a case has never been observed previously in the literature. An 8-cm rolled piece of newspaper was detected in the bladder using a cystoscope and was removed with open surgery.

Key Words: Bladder, Foreign body, Newspaper.

INTRODUCTION

The rate of hospital admissions due to a genitourinary foreign body is 7.6 in 100.000 people in the USA.¹ Genitourinary foreign bodies are generally observed with iatrogenic origin, self-insertion, sexual abuse, and rarely with the migration of foreign bodies from the nearby area. Genitourinary foreign bodies may take the form of sutures, stone formations or Foley’s catheter fragments as well as different materials such as magnetic balls, pens, or sewing needles.² The case in the present study included newspaper pieces inserted through the urethra into the bladder in an attempt to commit suicide, which has never been encountered in the literature before.

CASE REPORT

A 50-year male patient was admitted to the hospital with acute urinary retention and high-grade fever. A catheter was passed per urethra. The patient had mild haematuria. Upon detecting the appearance of stones in the bladder through ultrasound and having a C-reactive protein (CRP) value of 225 mg/dl, he was admitted due to urinary infection.

 

The patient was treated with empirical ceftriaxone. There was no change in the patient’s fever and no growth in the urine culture after three days of treatment. The catheter was changed due to the cessation of urine flow. During the change of the catheter, a four-cm-long folded newspaper was found in the urethra (Figure 1A), necessitating further enquiry. Upon questioning, the patient stated that he had only used the newspaper to clean his penis and it must have slipped and travelled inside his body. The patient underwent non-contrast abdominal computerised tomography (CT). Upon the detection of a foreign body in the bladder, as observed in Figure 1B from the CT scan, psychiatric consultation was recommended. In the psychiatric consultation, the patient stated that he had tried to commit suicide due to financial difficulties and that currently he did not have any suicidal tendencies. The patient stated that he did not use any device to insert the newspaper into his urethra. During surgery to remove the urethral obstruction, a significantly large piece of newspaper, approximately 8 cm in length (Figure 2), was visualised on cystoscopy and removed from the bladder. On the second postoperative day, the patient's drain was removed. On the 7^th postoperative day, the catheter was removed, and the patient was discharged.

DISCUSSION

Among the genitourinary organs, the organ where foreign bodies are most frequently seen is the bladder. Some symptoms of a foreign body in the bladder include haematuria, dysuria, frequent urination, and pelvic pain.³ In some cases, foreign bodies can cause problems such as vesicovaginal, vesicocutaneous, and urethrocutaneous fistula, etc.⁴

Figure 1: (A) The newspaper piece removed from the urethra in the patient discovered after catheter changes were made. (B) Upper and lower abdomen CT image of the patient without contrast.

Figure 2: A newspaper piece of approx. 8 cm in length removed from the bladder.

There are cases of a variety of foreign bodies detected in the bladder in the literature. Items such as iatrogenically sutured surgical clips, probe pieces, surgical equipment parts, or migration of intrauterine instruments have been identified. Other foreign bodies include materials used in the course of sexual abuse or self-insertion due to psychological issues. Some publications also show foreign objects such as thermometers, sewing needles, pencils, pens, and electrical wire. Additionally, foreign bodies are frequently observed in patients with neurogenic bladders. Many surgical methods have been used to remove foreign bodies.⁴ Endoscopic procedures have been successful in approximately 50% of patients, while open surgical procedures have been performed on other patients. One of the most interesting of these cases is the one published by Liu et al. in which 159 magnetic balls were endoscopically removed from the bladder.⁵ Another case report by Zaghbib et al. reported a 14-year-old teenager who used a 10 cm sewing needle for autoerection.⁶

The present case is exceptional for several reasons. For one, it has never been observed, especially in male patients, prior to this case. It included the insertion of newspaper into the bladder for psychiatric reasons and the purpose of suicide. Although discovering a foreign body in the bladder is rare, it should be considered in the differential diagnosis. Additionally, the patients’ history should be obtained thoroughly and should be supported by psychiatric consultation when necessary. It should also be highlighted here that a foreign body of up to 10 cm in size can be missed during x-ray due to being radiolucent, thus requiring the use of ultrasound. The surgeon dealing with the case is certainly the best person to decide which method to use to retrieve the foreign body, but it should be kept in mind when encountering such cases as these patients generally have multiple visits and re-interventions.

PATIENT’S CONSENT:
Informed consent was obtained from the patient.

COMPETING INTEREST:
The authors declared no competing interest.

AUTHORS’ CONTRIBUTION:
ME, YTO, MBK, NA: All the authors contributed to the concept, design, and drafting and approved the final version of the manuscript to be published.

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