Bladder foreign bodies

Foreign bodies of the urinary bladder are foreign objects introduced into its cavity from the outside. They can be different in composition, size and shape (head pins, pencils, thermometers, wire, bone tissue sequesters, gauze tampons, etc.). In case of urinary bladder injuries, wounding projectiles can be found in it.

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What causes bladder foreign bodies?

Most often, foreign bodies enter the bladder retrogradely through the urethra, less often through its wall from the tissues surrounding the bladder, and very rarely descending from the kidney through the ureter. They can penetrate from the pelvic organs, they are accidentally left in the bladder during various surgical interventions or diagnostic procedures.

There are four groups of reasons for the entry of foreign bodies:

• introduction of a foreign object by the patient himself (prank, masturbation, attempted criminal abortion, mental illness);
• accidental entry of a foreign body as a result of technical errors during manipulations and operations on the bladder and adjacent organs (ligatures, fragments of instruments, gauze balls or napkins);
• penetration of a foreign body into the bladder cavity due to gunshot wounds (bullet, shrapnel, bone fragments, scraps of clothing);
• migration of a foreign body into the bladder from adjacent organs during purulent-necrotic processes in them.

The symptoms of a foreign body in the bladder depend on its size, shape, chemical composition and the duration of its presence in it, as well as the effect of urine on it. Some objects quickly become covered with urinary salts, others are resistant to sedimentation, and others quickly increase in volume and become deformed.

Symptoms of Foreign Bodies in the Bladder

Symptoms of foreign bodies in the bladder include dysuria, hematuria (usually terminal), leukocyturia, and urinary incontinence in cases where the foreign object is trapped at one end in the neck of the bladder. Sometimes acute urinary retention develops.

Immediately after a foreign body enters the bladder, the victim experiences pain, which may be accompanied by dysuria.

Foreign bodies with a smooth surface can remain in the bladder for a long time without being accompanied by dysuria, which usually appears after an infection.

The symptoms of the disease are very similar to bladder stones, since the foreign body is the core of stone formation, which becomes overgrown with salts over time. Loose objects with sharp edges cause pain in the bladder when moving, which subsides at rest. Invariably, these patients have micro- and macrohematuria.

Complications of foreign bodies in the bladder

Pointed objects easily penetrate the wall of the bladder and perforate it. In this case, injury to the extraperitoneal part of the bladder leads to the development of paracystitis, and intraperitoneal - to peritonitis.

A long-term presence of a foreign body in the bladder causes the development of cystitis, often with ulceration of its mucous membrane. The kidneys are sometimes involved in the inflammatory process. Patients often have episodes of interruption of the urine stream, and in order to perform the act of urination they take a forced position. Urinary retention is also encountered, which requires catheterization of the bladder.

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Diagnosis of foreign bodies in the bladder

Diagnosis of foreign bodies in the bladder is not difficult in cases of typical anamnesis. Difficulties may arise when patients hide the fact of a foreign body entering the bladder, as well as when it is located under the mucous membrane of the bladder, when its wall is perforated from a paravesical abscess formed around a foreign object.

Often foreign bodies are encrusted with salts and can then simulate a bladder stone. Patients admitted for cystitis are not always informed about complications, such as a catheter breakage that occurred during its replacement, as well as the presence of gauze tampons or any medical instruments in the bladder. The clinical picture of the disease resembles that of a bladder stone, and in women, especially young women, this is extremely rare, so only in a confidential conversation with the patient can one understand the nature of the disease.

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Instrumental diagnostics of foreign bodies in the bladder

During vaginal examination, the posterior wall of the bladder is dense and painful. In thin women, a foreign body is palpated when the bladder is free of urine. In men, a foreign body in the bladder can be palpated through the rectum.

Cystoscopy provides very valuable information, as it is easy to examine an object that has entered the bladder when the mucous membrane is not inflamed; however, with the development of cystitis, examination is difficult and sometimes impossible. Cystoscopy is not feasible when the bladder capacity is sharply reduced or when its entire cavity is filled with a foreign body.

X-ray or ultrasound examinations can easily detect surgical instruments that have migrated into the bladder from the abdominal cavity or were accidentally left in it. Sometimes other foreign bodies are also detected.

Treatment of foreign bodies in the bladder

Patients with foreign bodies in the bladder are treated strictly differentially. All foreign bodies are subject to removal. In peritonitis and acute paracystitis, urgent surgical treatment is necessary.

Foreign bodies in the bladder that are not accompanied by pain and dysuria should be removed on a planned basis.

The method of choice is considered to be transurethral instrumental removal using an operating cystoscope. Removal of a foreign body through the urethra is possible under the following conditions:

• the foreign body is not fixed;
• there is no or very moderate inflammation of the lower urinary tract;
• the size of the foreign body allows it to pass through the urethra without damaging it.

Small plastic foreign bodies are removed with special forceps included in the surgical kit. A Dormia-type loop can be used for the same purposes.

Endovesical manipulations are easier to perform in women due to the anatomical features of the urethra. Sometimes two instruments can be used simultaneously. In the case of a suprapubic vesical fistula, the foreign body is removed (for example, the head of a Pezzer catheter) by epicystoscopy. Large objects are first crushed and then removed in parts or aspirated.

Large, sharp, metallic, and other unknown objects encrusted with salts, which cannot be removed endovesically or are dangerous, should be removed by epicystotomy. Technically performed in the same way as cystolithotomy. After this operation, the bladder is usually sutured tightly, leaving a permanent catheter for 5-7 days. If purulent cystitis is detected in the bladder during surgery, after removal of the foreign body, a suprapubic bladder fistula is indicated for a short time.

Antibacterial therapy is prescribed in the postoperative period.

Prognosis of foreign bodies in the bladder

Foreign bodies in the bladder have a favorable prognosis if removed in a timely manner.

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