Case presentation
A woman in her thirties was referred to our center with a complaint of
difficulty in removing an FB inserted into her urinary bladder through
the urethra. She also complained of lower abdominal pain and admitted
that she inserted the FB by herself through her urethra for sexual
gratification. She had no history of illness, including a psychiatric
one. Her blood sample test revealed an almost normal but slightly
elevated C-reactive protein of 0.21 mg/dl. Cystoscopy was immediately
performed in the outpatient care unit, which revealed a rod-shaped FB
stuck into her left bladder wall (Figure 1a). Pelvic computed tomography
(CT) revealed that FB had completely penetrated the left bladder wall,
but its tip did not appear intraperitoneally (Figure 1b-d). She was
diagnosed with bladder FB complicated by bladder perforation. She
underwent a surgical exploration instead of transurethral FB excision
because the presence of peritoneal injury was not excluded. The Retzius
cavity was expanded and a cystostomy was made through a lower abdominal
Pfannenstiel incision. The FB turned out to be a 9.5-cm long plastic
Asian traditional hair stick called kanzashi in Japanese (Figure
2a). The peritoneum was confirmed to be intact, consistent with the CT
diagnosis, although the hair stick penetrated the bladder wall (Figure
2b). The bladder wall was fixed by suturing in two layers. Her
postoperative course was uneventful, and the urethral catheter was
removed 6 days postoperatively after a cystography confirmed no leakage.
She was recommended to stop the urethral sounding after her discharge.
We also suggested that she use medical intermittent catheters instead of
kanzashi as a tool for sounding If she could not stop it. However, she
denied our suggestion, and our postoperative followup was terminated.