Rahman Nadeem U, Elliott Sean P, McAninch Jack W
Department of Urology, University of California School of Medicine, and San Francisco General Hospital, San Francisco, California, USA.
BJU Int. 2004 Nov;94(7):1051-3. doi: 10.1111/j.1464-410X.2004.05103.x.
To evaluate the cause, diagnosis, management and complications of self-inserted urethral foreign bodies in men, reviewing a 17-year experience.
From November 1986 to January 2004, 17 men were treated for self-inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications.
In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton-tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body.
Self-inflicted urethral foreign-body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow-up, albeit difficult in these patients, is desirable.
回顾17年的经验，评估男性自行插入尿道异物的原因、诊断、处理及并发症。
1986年11月至2004年1月，17例男性因自行插入尿道异物接受治疗；对其病历进行回顾性分析，以了解临床表现、诊断、处理及并发症情况。
所有17例患者的异物均可清楚触及。异物包括扬声器线、一枚AAA电池、开口安全别针、一个塑料杯、吸管、一颗弹珠及一支棉拭子。最常见的症状是尿频伴排尿困难，但有时出现肉眼血尿及尿潴留。插入异物的原因各异；精神障碍最为常见，其次是中毒，仅5例患者是因性刺激所致。所有患者均接受了诊断性影像学检查；14例患者仅通过骨盆平片即可明确，3例患者需要超声或计算机断层扫描。除1例患者外，所有患者均通过内镜成功取出异物，该例患者需要行会阴尿道切开术。最常见的并发症是黏膜撕裂和假道形成。尿道狭窄与多次尝试插入异物有关。
男性自行插入尿道异物的情况并不常见。进行放射学评估以确定异物的确切大小、位置及数量很有必要。内镜取出通常成功，且需要使用抗生素。建议对所有患者进行精神科评估，必要时给予适当的药物治疗。晚期表现包括尿道狭窄疾病，尽管对这些患者进行密切随访存在困难，但仍很有必要。
