Features of the extraction of foreign bodies from the lower urinary tract

BACKGROUND:Foreign bodies introduced by patients into the bladder and urethra are relatively rare in clinical practice. As a result, there is insufficient information in the scientific literature regarding methods of extracting foreign bodies from the urinary tract. AIM:determination of the optimal methods for extracting foreign bodies from the urethra and bladder. MATERIALS AND METHODS:Foreign bodies of the lower urinary tract were removed in 21 patients: 15 (71.4%) men and 6 (28.6%) women. Foreign bodies were found in the urethra in 7 (33.3%) patients and in the bladder in 14 (66.7%) patients. Removal of foreign bodies from the urethra and bladder was performed endoscopically or during open surgery. RESULTS:Removal of stabbing, cutting and glass objects from the urinary tract in 9 patients was performed during open surgery. Foreign bodies with even smooth edges were removed in 12 patients under urethrocystoscopic control. At the same time, in two patients, coagulated suppositories were first fragmented in the bladder cavity, and then removed in parts. Cystolithotripsy was performed in one patient with a suppository inlaid with calculus before fragmentation. CONCLUSIONS:Foreign bodies with sharp edges or made of glass are safer to be removed from the lower urinary tract during open surgery. Foreign bodies with a smooth and even surface are optimally removed endoscopically. Long and bulky foreign objects that can be fragmented in the bladder cavity are best removed in parts. When foreign bodies are encrusted with large calculi, cystolithotripsy should be performed before their endoscopic extraction.

Differentiated approach of using extraction balloon catheters in endoscopic biliary surgery

Aim. Expand and determinate indications for using of extraction balloon catheters in endoscopic biliary surgery, as an additional and auxiliary endoscopic technique, which optimizes the technical conditions for performing medical and diagnostic tasks.Material and methods. We used disposable two- and three-lumen extraction balloon catheters with a diameter of 7.5 Fr. The catheters assumed delivery of an extractor balloon along a conductor with a diameter of 0.35 in into the bile duct, and also made it possible to inject a radiopaque substance. 136 retrograde endoscopic interventions were performed on the bile ducts using extraction balloon catheters.Research results. Indications for the use of an extractor balloon have been determined and proposed as a conventional standard. Interventions on the bile ducts were carried out using only a balloon catheter and in combination with a Dormia basket (n = 61). An extraction balloon catheter was used during retrograde endoscopic intervention on the bile ducts as an additional diagnostic endoscopic manipulation to facilitate the performance of the diagnostic task (n = 38). The device was also used to optimize the technical conditions of medical and diagnostic tasks (n = 37). 116 patients had benign diseases, 20 patients had tumor lesion.Сonclusion. The main function of an extraction balloon catheter is to move or displace the contents from the proximal to the distal parts of the bile duct, followed by its extraction into the duodenum. The design characteristics of the instrument make it possible to significantly expand the indications for its use, including not for its intended purpose, but as an additional method, optimizes the technical conditions for performing medical and diagnostic tasks. The endoscopic extraction balloon catheter is a multipurpose instrument that can be used to solve both diagnostic and therapeutic tasks of retrograde interventions on the bile ducts.

Perforation Due to Biliary Stent: Case Report and Review

Endoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.

“Self-inflicted ballpoint pen in a male urinary bladder and successful endoscopic management - a rare case report ”

Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra. Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction. Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available

CERVICAL OESOPHAGOTOMY IN A CAT FOR FOREIGN BODY REMOVAL - CASE REPORT

Oesophageal foreign bodies are a significant cause of morbidity and mortality in small animals, especially in carnivores. Due to the possibility of complications such as perforation or tracheal compression, the patient may present an upper airway obstruction, which might become a medical emergency. Here, we describe a rare case of a large cervical foreign object in a cat and review the diagnostic and therapeutic approach of this condition. A 4-year-old female cat was referred to our clinic with signs of dyspnoea, dysphagia and regurgitation. The history and clinical exam suggested an oesophageal foreign body, subsequently radiographically confirmed. Because its shape and position did not allow endoscopic extraction, the foreign body was removed via ventral cervical oesophagostomy. Due to its location and large size, it was necessary to fragment the foreign body into two pieces for complete extraction without injuring the oesophageal walls. The patient had no postoperative complications and was discharged 7 days after surgery. In this condition, an early diagnosis, followed by an immediate surgical repair and a rigorous postoperative care, correlates with patient recovery and survival, being crucial in reducing the high morbidity and mortality rates that are usually associated.

“Self-inflicted ballpoint pen in a male urinary bladder and successful endoscopic management - a rare case report ”

Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra.Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction.Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available

Endoscopic management of intentional foreign body ingestion: experience from a UK centre

ObjectiveWe report on the increasing incidence and outcomes from intentional foreign body ingestion (iFoBI) presenting to our hospital over a 5-year period. The aim was to assess the impact on services and to identify ways to safely mitigate against this clinical challenge.Design/methodWe performed a retrospective observational study of all patients presenting to a university hospital between January 2015 and April 2020 with iFoBI with a focus on objects swallowed, timing of endoscopy and clinical outcomes.Results239 episodes of iFoBI in 51 individuals were recorded with a significant increase in incidence throughout the study period (Welch (5, 17.3)=15.1, p<0.001), imposing a high burden on staff and resources. Items lodged in the oesophagus were more likely to lead to mucosal injury (p=0.009) compared with elsewhere. Ingested item type and timing of endoscopy were not related to complications (p=0.78) or length of stay (p=0.8). In 12% of cases, no objects were seen at endoscopy.ConclusionIn all except those patients with oesophageal impaction of the object on radiograph, there is no need to perform endoscopic extraction out of hours. A subset of cases can avoid endoscopy with an X-ray immediately prior to the procedure as a significant proportion have passed already. We discuss more holistic approaches to deal with recurrent attendances.