Department of Surgery, University of Gondar Specialized Hospital, Gondar, Ethiopia.
BMC Urol. 2023 Mar 10;23(1):36. doi: 10.1186/s12894-023-01204-x.
Urethral obstruction due to retained projectile migrating into the genitourinary system has rarely been reported. The literature describes two main methods of retained projectile removal from the genitourinary system: (1) spontaneous expulsion during voiding and (2) manual extraction due to urethral obstruction causing acute urinary retention.
We present a case in which a 23-year-old man presented with acute urinary retention four days after suffering a gunshot wound to the right distal posterolateral thigh. A retained projectile eroded through the posterior wall (slightly to the right) of the bulbar urethra at the bulb, migrated through the urethra, and eventually became lodged in the external urethral meatus, causing obstruction and acute urinary retention. Subsequently, the foreign body was removed with manual extraction along with gentle external pressure under sedation and the patient was discharged with a 16 Fr transurethral catheter in situ to be kept for 1 week and removed after a week.
The absences of signs do not always effectively rule out urethral or bladder injury. Urethral foreign bodies are not commonly encountered when they do the entry is usually the urethral meatus. However, the treating physician must that other mechanisms also exist especially in those with bullet injury to flank, abdomen, pelvis and even the distal thigh like our case.
由于遗留弹丸迁移到泌尿生殖系统而导致的尿道梗阻很少见。文献描述了从泌尿生殖系统中取出遗留弹丸的两种主要方法：（1）在排尿时自发排出；（2）由于尿道梗阻导致急性尿潴留而进行手动提取。
我们报告了一例 23 岁男性的病例，该患者在右大腿远端后外侧遭受枪击伤四天后出现急性尿潴留。遗留弹丸侵蚀了球部尿道的后壁（略偏右侧），通过尿道迁移，最终嵌顿于尿道外口，导致梗阻和急性尿潴留。随后，在镇静下通过手动提取并轻轻施加外部压力将异物取出，患者出院时留置 16Fr 经尿道导管原位 1 周，1 周后取出。
缺乏迹象并不总能有效地排除尿道或膀胱损伤。当尿道异物进入时并不常见，通常是尿道外口。然而，治疗医生必须认识到其他机制也存在，特别是在那些有枪弹伤的病例中，包括侧腹部、腹部、骨盆，甚至是像我们病例中的大腿远端。
