Surgical paper XVI
A case of plastic tube foreign body in the bladder
- Gender: Male
- Age: 20
- Occupation: Farmer
- Hospital Admission Number: 16318
On April 5, 1990, out of curiosity and playfulness, the patient self-inserted a 35-cm hollow plastic tube designed for hair-tying into his bladder via the urethra and was unable to remove it. He subsequently developed symptoms of lower urinary tract irritation, including frequent urination, urgency, and painful urination. Local hospital urine tests revealed pyuria (++), but a plain film of the bladder was reported as negative. Due to the concealment of this medical history, treatments for cystitis were ineffective. The patient was admitted to the hospital on December 3, 1990.
General conditions were normal. Urinalysis showed red blood cells (++) and pyuria (x10). B-mode ultrasound revealed a hyperechoic mass within the bladder. A plain film of the bladder showed a circled mass (Figure 1). The diagnosis was a foreign body in the bladder accompanied by stone formation.
On an unspecified day in December 1990, the patient underwent a cystotomy under continuous epidural anesthesia. A solid foreign body, measuring 2×2.5×3.0 cm and weighing 5.5 grams, was removed (Figure 2). It consisted of five loops of the plastic tube, folded upon themselves, with extensive urine salt deposition.
Insights and Reflections
This case underscores the importance of a detailed medical history for accurate diagnosis. After the operation, we conducted a simulation using a hollow plastic tube similar to the one in the patient’s case and found that if the conditions are right and the films are read carefully, the foreign body could indeed be identified. However, in the early stages of this case, the local hospital misinterpreted a bladder plain film as negative and incorrectly treated the patient for cystitis. This not only prolonged the symptoms but also led to the deposition of urine salts around the foreign body, turning it into a calcified mass. Essentially, this became a case of secondary bladder calculus.
Interestingly, because the foreign body served as the core around which salts aggregated, it did not readily cause obstruction during urination. Thus, symptoms like interrupted urine flow or “staccato” urination were absent. Instead, the patient continued to experience pain and symptoms of bladder irritation. The correct diagnosis was eventually made based on the patient’s medical history, B-mode ultrasound, and X-ray examinations.
Given the specific circumstances of this case, attempting to break and remove the stone via the urethra seemed implausible and would likely result in remnants. Complete surgical removal of the mass proved to be the most effective treatment approach.
(1991/10/05), Changhang Hospital, Li Mingjie & Shi Lianghui