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07-13-2014, 04:22 PM
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Self-Inserted Headset Antenna into Penis
Bedside Ultrasound in Workup of Self-Inserted Headset Cable into the Penile Urethra and Incidentally Discovered Intravesical Foreign Body A developmentally delayed 64-year-old gentleman with a history of recurrent urinary tract infections presented to the emergency department with an intraurethral foreign body. According to the patient’s caregiver, he had been experiencing intermittent symptoms of suprapubic pain, dysuria, and low-grade fevers for the past six weeks. At an outside facility, he was diagnosed with recurrent urinary tract infections and was treated with empiric antimicrobial therapy without improvement. On the morning of presentation, the patient was found by his caregiver to have a fishing line and a black electric cable protruding from his penile urethra with an intact headset attached externally (Figure 1). The patient was known to have a hobby of making necklaces out of fishing line and beads. He lived in a group home and also had a history of inserting foreign objects in his rectum but had no known history of inserting objects in his urinary tract. Upon questioning, the patient could not articulate his motivation for inserting these objects into his lower urinary tract. On examination the antenna was palpable to the distal half of the penis and a plain pelvic X-ray demonstrated that the antenna did not extend beyond the penile urethra. A radioopaque coil was noted within the pelvis (Figure 2). Prompt bedside ultrasound in the emergency department revealed a separate coil of radioopaque material in the bladder (Figure 3). An anesthetic penile block was performed and the fishing line with two plastic beads attached and the antenna of the headset were successfully removed from the penile urethra using gentle traction. Bedside cystoscopy was performed to remove a coil of electrical wire with mild calcifications from the bladder (Figure 4). Following the procedure, the patient was able to void without difficulty. The patient was subsequently discharged home from the emergency department with a five day course of antibiotics. Figure 1: Patient on initial presentation with headset antenna inserted into the penile urethra. A piece of transparent fishing line was also found to be protruding from the urethral meatus alongside the atenna; however, it is not visible in this figure. Figure 2: Plain film demonstrating antenna in penile urethra and radiopaque foreign body within the pelvis. Of note the fishing line with attached beads was not visible. Figure 3: Bedside ultrasound demonstrating hyperechoic object within the bladder. Figure 4: Electric wire with calcifications removed by bedside cystoscopy. |