The time-less urologic question, “Now why would you do that?” A case series and literature review of self-inserted urethral foreign bodies

Objective: Self-inserted urethral foreign bodies are relatively uncommon with few cases reported in the literature. Urethral sounding may result in a retained urethral foreign body commonly occurring in men as a form of masturbation. We present a retrospective case review from a single facility over an eight-month period; discuss the limited literature available rationale and management of self-inserted urethral foreign bodies. Material and methods: In an 8-month period of time, there were eight reported cases of intentional self-inserted urethral foreign bodies, involving three male patients. The patient characteristics varied in age, race, and type of foreign body. The reasons for placement also varied, with sexual gratification being most common. All three patients had a diagnosis of schizophrenia. Diagnosis was made using clinical history, physical examination, imaging studies, and confirmation done with endoscopic visualization of the foreign body. Results: All eight cases were successfully treated via minimally-invasive procedures, either with endoscopic removal or by manual expression of the foreign body out of the urethra. None of the eight required open surgery, and most were treated successfully at the bedside in the emergency room. Only two of the cases required endoscopic removal under anesthesia. After removal of the foreign bodies, all of the patients were able void without difficulty, and also underwent psychiatric evaluation prior to discharge. Conclusion: Urethral foreign bodies can be a result of sexual foreplay in the form of urethral sounding. It has been reported that 10% of 2122 men surveyed admitted to recreational urethral sounding. Common motivations were sexual or erotic in nature. Risky behavior including substance abuse was also reported. Psychiatric disorders have also been reported and psychiatric evaluation is recommended in all cases. A minimally invasive approach should always be attempted. Although rarely reported in the literature, self-inserted urethral foreign bodies should be on the differential in a patient with appropriate symptoms. This is especially true if the patient has a history of substance abuse, psychiatric illness, mental retardation or dementia.