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Strange Days: Medical Bag

 

What's Up, Cock?

The bizarre objects people stick up their own urethras

Med Bag - what's up cock?

X-ray of a 59-year-old patient shows multiple metallic objects approx. 1cm in diameter in the anterior and posterior urethra. Don't try this at home.
Int. Brazil J Urol.

FT262

Bet this story won’t appear on Casualty. A 50-year-old man reported to a British A&E department dribbling urine, suffering painful spasms in his pelvis – and with two ends of a thin telephone wire dangling some five inches from the end of his penis. He’d been unable to maintain an erection since suffering a heart attack four years previously. So, for the last three years, he’d inserted telephone wire into his urethra to obtain an erection suffic­ient for masturbation. Usually, he just pulled the wire out. But this time the cord stuck. An X-ray showed both smooth and coiled telephone wire running along his urethra and ending deep in his bladder. Fortunately, surgeons successfully removed the cable. [1]

Over the years, numerous people – including men and women, children and the elderly – sought medical attention with a bewildering array of objects in their urethras and bladders. Surgeons removed – among many other things – pencils, toothbrushes, candles, balloons, hairpins, [2] light bulbs, tweezers, drawing pins, [3] feathers, kidney beans, [4] intrauterine devices [5] and expandable foam sealant, which left the doctors with “a perfect mould of the bladder and prostatic urethra”. [6]

As mentioned below, some of these arrived in the bladder accidentally or during an assault.Leeches can wiggle up the urethra while the patient is bathing in a river, for example. In the 1930s, a 40-year-old labourer in Australia complained that he needed to urinate hourly throughout the day and night, and endured pain and passed blood during urination. Five months previously, he’d been in a drinking bout with some friends. He couldn’t remember much, but the following morning he noticed a swelling on his scrotum and assumed he’d been kicked. However, surgery revealed a leather bootlace in his bladder. The patient denied all knowledge of how the bootlace reached his bladder. The surgeons suggested that his companions might have inserted the bootlace during the drinking bout and advised the labourer “to be more careful in future about the company he kept”. [7]

Nevertheless, many patients introduced the objects deliberately. In one recent case, for example, a 51-year-old Austrian man managed to insert a 9cm-long Allen key completely into his urethra. [8] Even more bizarrely, a surgeon found three vertebræ from a squirrel in the centre of a bladder stone removed from a 35-year-old man who had used the animal’s tail to masturbate. Another surgeon reported that an old shepherd killed a dog and cut off the animal’s penis. The shepherd inserted the dog’s penis into his urethra to maintain an erection. Three weeks later, surgeons removed the dog’s penis from the shepherd’s bladder. [9] Makes you grateful for Viagra.

Introducing objects into the urethra isn’t a modern fad – although some of the reasons given by patients changed. In 1897, Francis Packard, a doctor in Philadelphia, reported cases where patients inserted pipe stems, bone crotchet needles, hair and shawl pins, chewing gum and cylinders of pork or potato into their urethras. Apart from “sexual excitement”, 19th-century Americans inserted objects into their urethras to relieve irritation, tackle urinary retention, alleviate incontinence, prevent nocturnal emissions, treat gonorrhœa or induce abortion. [10] Today, drugs tackle many of these problems. So most insertions are sex­ually motivated, such as to add rigidity to the penis or induce an autoerotic thrill. Perhaps we’re also more willing to admit to a sexual motive.

Yet not every object that ends up in the bladder made its way via the urethra. A sharp object can pierce the coiling intest­ine’s wall, migrate through the abdomen and reach the bladder. [11] Surgeons have removed ingested chicken and fish bones, pins and needles, pencils, thermometers and toothpicks from the bladder after the object perforated the gut wall. [12] In 1885, a surgeon removed a bladder stone from a four-year-old that formed around a darning needle that the boy’s mother saw him swallow 18 months before. [13] The great French surgeon Felix Legueu (1863–1939) reported an unusual shrapnel injury: a sou (a French coin) flew from the pocket of one soldier, who died, and into the bladder of his comrade alongside him. [14]

Similarly, in August 1919, a solider who’d returned from World War I was walking downstairs with a bullet in his mouth. (The authors don’t explain the appeal of oral ammunition.) He stumbled and swallowed the bullet. The solider kept an eye on his fæces, but couldn’t spot the bullet. Then, three weeks later, he endured a bout of diarrhœa with rectal pain that lasted 10 days. Three months after his diarrhœa cleared up, he started suffering pain and passing blood when he urinated. Surgeons found a “salt-encrusted bullet” stuck to the back wall of his bladder. The bullet probably passed through the wall of the rectum and into his bladder. [15]

As a final example, 19th-century surgeons removed a stone from the bladder that formed around a whalebone pipe mouthpiece that retained the odour of tobacco. “The man persisted in asserting he had swallowed [the mouth piece] a long time before”. [16]

I bet that’s what they all say.



Notes
1 RK Trehan, A Haroon, S Memon, D Turner: “Successful removal of a tele­phone cable, a foreign body through the urethra into the bladder: a case report”, J Med Case Reports 1:153, 2007.
2 J Cury, RF Coelho, M Srougi: “Retroperitoneal migration of a self-inflicted ballpoint pen via the urethra”, Int Braz J Urol 32:193–5, 2006.
3 JM Osca, E Broseta, G Server et al: “Unusual foreign bodies in the urethra and bladder”, Br J Urol 68:510–2, 1991.
4 HP Winsbury White: “Foreign bodies in the urinary bladder”, Brit J Urology 2:27–35, 1930.
5 W Kochakarn & W Pummanagura: “Foreign bodies in the female urinary bladder: 20-year experience in Ramathibodi Hospital”, Asian J Surg 31:130–3, 2008.
6 ED Kim, A Moty, DD Wilson, D Zeagler: “Treatment of a complete lower urinary tract obstruction secondary to an expandable foam sealant”, Urology 60:164, 2002.
7 AW Badenoch and RI Campbell: “Foreign bodies in the urinary bladder with a report of two cases”, British Journal of Surgery 25;133-138, 1937.
8 M Mitterberger, R Peschel, F Frauscher, GM Pinggera: “Allen key completely in male urethra: a case report”, Cases J 2:7408, 2009.
9 White, op cit.
10 A sharp object can pierce the wall of the uterus and migrate to the bladder. See Kochakar, op cit.
11 White, op cit.
12 Cury, op cit.
13 FR Packard: “An Analysis of Two Hundred and Twenty-One Cases of Foreign Body introduced into the Male Bladder per Urethram, with Report of a Recent Case”, Ann Surg 25:568–99, 1897.
14 White, op cit.
15 Badenoch, op cit.
16 Packard, op cit.

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