A rare case of self-inflicted foreign body in the urethra of a pediatric patient which was successfully managed with urethrotomy converted into urethrostomy: a case report

Background: Foreign bodies that are self-inserted into the urethra is an uncommon urological emergency amongst the pediatric group of patients. These patients almost always hide their symptoms due to the feeling of embarrassment, which makes diagnosing such cases difficult. Case Description: We report an uncommon case of 10 needles which were self-inserted into the urethra by a 5-year-old boy. This case is complex as there are numerous needles inside the urethra which makes the standard transurethral route of cystoscopic retrieval difficult. To date, there are no similar cases reported in literatures. To locate the exact location, size and configuration of the foreign body, one can use plain radiography, ultrasound assessment or computer tomography (CT) scan. Each of these modalities have their own benefits. In this current case, we opted for plain radiography followed by ultrasound assessment. The goal of treatment is to remove the foreign body with minimal complication as possible. Urethrotomy was performed via perineal incision and 10 needles were removed successfully. The rationale behind this procedure was that there were too many needles to be removed cystoscopically. This will also prevent the possibility of urethral injury as the needles are sharp in nature. The urethrotomy was converted into urethrostomy as primary closure was not feasible due to the concerns of a stricture formation. He experienced a smooth recovery and was discharged in good health on the third day of his hospital stay. Psychiatric evaluation was done prior to discharge which revealed that the patient had autism spectrum disorder. The patient remained well throughout the follow up at first and third month in which later the urethrostomy was closed as the patient established normal voiding without any complications. Conclusions: Foreign body that are located within the urethra remains rare amongst the pediatric age group. Comprehensive approach towards these kinds of patients would be beneficial. The approach to diagnosis and treatment must be personalized to suit the unique circumstances of each case.