Foreign bodies of the bladder

Foreign bodies of the 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 sequesters, gauze tampons, etc.). When a bladder is injured, wounding shells can be found in it.

[1], [2], [3], [4], [5], [6], [7],

What causes foreign bodies of the bladder?

Most often, foreign bodies enter the bubble in a retrograde way through the urethra, less often through its wall from the surrounding tissue and extremely rarely downward from the kidney along 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 to the patients themselves (prank, masturbation, attempted criminal abortion, mental illness);
• accidental ingress of a foreign body as a result of technical mistakes during manipulations and operations on the bladder and neighboring organs (ligatures, instrument debris, gauze balls or napkin);
• penetration of a foreign body into the bladder cavity with gunshot wounds (a bullet, a fragment, fragments of bones, scraps of clothing);
• migration of a foreign body into the bladder from neighboring organs with purulent-necrotic processes in them.

Symptomatology with a foreign body of the bladder depends on its size, shape, chemical composition and duration of stay in it, it also has the impact of urine on it. Some objects are quickly covered with uric salts, others show resistance to sedimentation, others quickly increase in volume and deform.

Symptoms of foreign bodies of the bladder

Symptoms of foreign bodies of the bladder - dysuria, hematuria (often terminal), leukocyturia, urinary incontinence in cases when an extraneous object is restrained by one end in the neck of the bladder. Sometimes acute urination retention develops.

Immediately after the foreign body enters the bladder, the victim experiences pain, to which dysuria can join.

Foreign bodies with a smooth surface can be in the bladder for a long time, without accompanying dysuria, which appears, usually after infection.

Symptoms of the disease in many ways resemble the stones of the bladder, because the foreign body is the core of the stone formation, overgrown with time salts. Free objects with sharp edges cause pain in the bladder during movement, which subsides at rest. Invariably, these patients observe micro- and macrohematuria.

Complications of foreign bodies of the bladder

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

The prolonged stay of a foreign body in the bladder causes the development of cystitis, often with ulceration of its mucous membrane. In the inflammatory process, kidneys are sometimes involved. Often, patients have episodes of interruption of the urine stream, and for the implementation of the act of urination, they occupy a compulsory position. There is also a delay in urination, which requires a catheterization of the bladder.

[8], [9], [10], [11], [12], [13]

Diagnosis of foreign bodies of the bladder

Diagnosis of foreign bodies of the bladder is simple in cases of a typical anamnesis. Difficulties can arise when patients hide the fact of foreign body entering the bladder, as well as when it is located under the mucous membrane of the bladder, with the perforation of its wall from the paravezical abscess formed around the foreign object.

Often foreign bodies are encrusted with salts and then they can simulate a stone of the bladder. Patients coming in for cystitis are not always informed about the complications, for example, the 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 the one with a stone of the bladder, and in women, especially young women, this is extremely rare, so only in a confidential conversation with the patient can you understand the nature of the disease.

[14], [15], [16], [17], [18]

Instrumental diagnosis of foreign bodies of the bladder

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

Very valuable information is given by cystoscopy, in which it is easy to examine an object that has fallen into the bladder when the mucous membrane is not inflamed, however, with the development of cystitis, the examination is difficult and sometimes impossible. Cystoscopy is not feasible with a sharply reduced capacity of the bladder or the filling of its entire cavity with a foreign body.

With an X-ray examination or ultrasound, surgical instruments that migrate into the bladder from the abdominal cavity or are accidentally left in it are easily detected. Sometimes other foreign bodies are found.

Treatment of foreign bodies of the bladder

Patients with foreign bodies of the bladder are treated severely differentially. All foreign bodies are to be removed. With peritonitis and acute paracystitis, urgent surgical treatment is necessary.

Foreign bodies of the bladder, not accompanied by pain and dysuria, must be removed in a planned manner.

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

• foreign body is not fixed;
• the inflammation of the lower urinary tract is absent or very moderately pronounced;
• the dimensions of the foreign body allow it to pass through the urethra without damaging it.

A special pliers, included in the set of the operating set, remove small plastic foreign bodies. You can use a Dormia type loop for the same purposes.

Endovezical manipulations are easier to perform in women because of the anatomical features of the urethra. Sometimes you can use two instruments at the same time. With the suprapubic urinary bladder, a foreign body is removed (for example, the head of a catheter of Peccera) by episcystoscopy. Objects of large size are first crushed, and then removed in parts or aspirated.

Large, sharp, metallic, as well as other unknown objects encrusted with salts, which can not be removed endovezically or can be safely removed by epicystotomy. Technically performed as well as cystolithotomy. After this operation, the bladder is most often sewn tightly leaving the permanent catheter for 5-7 days. If purulent cystitis is found in the bladder during surgery, after removal of the foreign body, superposition of the suprapubic urinary fistula is shown for a short time.

In the postoperative period, antibacterial therapy is prescribed.

Forecast of foreign bodies of the bladder

Foreign bodies of the bladder have a favorable prognosis with their timely removal.

[19], [20], [21], [22], [23]