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UROlogy or UFOlogy: Sometimes There’s Not Much of a Difference
The words “urology” and “ufology” differ by only one letter, and the letters “f” and “r” are structurally similar. Ufology concerns unidentified flying objects, whereas urology concerns the urinary tract—seemingly disparate concerns, but at times convergent, the topic of today’s entry.
u·fol·o·gy
/yo͞oˈfäləjē/
noun
1. the study of UFOs.
u·rol·o·gy
/yo͝oˈräləjē/
noun
1. the branch of medicine and physiology concerned with the function and disorders of the urinary system.
Although unidentified objects are most commonly seen in the sky, sometimes they are found at sea level, and at times within the confines of the human body. The urethral opening of the urinary tract provides ready access to foreign bodies, and every now and then urologists are confronted with a patient who has placed an object within the urethra that gets stuck within the lower urinary tract. Although not always the case, a major psychological/psychiatric issue is commonly found to be one of the contributing factors.
Many foreign bodies are inserted for erotic self-gratification or sexual curiosity, often while under the influence of alcohol. On occasion, an impacted foreign body is found to have been inserted by a partner during sex play or as a result of a physical assault or sexual abuse.
Urinary tract foreign bodies may also result from urinary tract instrumentation by urologists, penetrating trauma, and rarely from an intra-uterine contraceptive devices or pessary that migrates and erodes from the genital tract into the urinary tract. On rare occasions, even patients who have had their bladder removed and their urine diverted into a piece of intestine that is brought out to the skin are found to have inserted foreign bodies into this intestinal conduit or reservoir.
When I was a urology resident at U Penn in Philadelphia many moons ago we had a “frequent flyer” to the emergency room who was a mentally disturbed young man who often showed up with hardware in his urethra. He lubricated his urethra with olive oil and then used a chopstick to push metal nuts and bolts deeply into his urethra, where they became embedded and had to be surgically removed.
Foreign bodies have been found in the urinary tracts of children and adults of both genders, although adult males are the predominant demographic. The problem is not necessarily the insertion of a foreign body, but the situation that arises when it cannot be retrieved and remains lodged within the urinary tract. Urinary tract foreign bodies cause a variety of symptoms, including pelvic pain, burning with urination, frequent urinating, urinary infection, inability to urinate and blood in the urine. It is common for patients who have inserted foreign bodies that have become embedded within the urinary tract to be reluctant to present for medical care because of the embarrassing nature of the problem thus causing treatment delays.
A great variety of objects have been retrieved from the urethra and/or urinary bladder, including ballpoint pens, lead pencils, pencil erasers, eyelid pencils, Q-tips, coils of metallic wire, charging cables, paper clips, thermometers, chopsticks, bullets, pins, nuts and bolts, straws, stones, magnetic beads, plastic toys, chicken bones, IUDs and pessaries. Broken components of endoscopic instruments, pieces of catheters, stents, calcified sutures, and surgical clips have also been implicated.
X-ray imaging can detect foreign bodies that are radiopaque (visible on an X-ray), while ultrasonography or CT is can detect foreign bodies that are radiolucent (not visible on an X-ray). Cystoscopy–using a tiny lighted instrument to view the lower urinary tract– is the most accurate means of further evaluation. If the foreign body is hanging out of the urethra, at times simple traction can be used to remove it after appropriate imaging to ensure that the foreign body is not coiled within the urethra or bladder. If the foreign body is entrapped within the lower urinary tract, treatment requires careful removal of the foreign body.
Urologists have sophisticated tools and the skillset in minimally-invasive endoscopy to be able to remove most of these foreign bodies endoscopically with only the rare necessity for open surgical procedures. The specific procedure is determined by the characteristics of the foreign body—its size, shape, and mobility as well as the specific location within the urinary tract.
Bottom Line: The self-insertion of foreign bodies into the urethra is an uncommon, but well-documented practice occurring mainly during pathological masturbation, intoxication, or secondary to psychological disturbances. A wide variety of objects have been implicated. Occasionally, foreign bodies are found on the basis of migration/ erosion into the urinary tract, penetrating trauma, or as the result of retained pieces of catheters or instruments used during urological surgery.
