Self-insertion of needle as urethral foreign body after sexual gratification : An unusual case report

Self-inserted foreign bodies in the urethra are rare among children. We describe here a 13-year-old boy who had self-inserted a needle into his urethra. Selfinsertion of the needle wrapped with cotton into the urethra for cleaning after masturbation by patient was applied. A foreign body in the urethra was removed by cystoscopy.


INTRODUCTION
Self-insertion of the foreign body into the urethra in male children has been rather uncommon reported in the literature [1,2].
Self-insertion foreign bodies are varied as pins, wires, screws or ball point pens [3,4].
The causes of self-insertion are autoerotic stimulation, psychiatric illness, therapeutic purposes, or no definite reasons by the patient [1,5,6].The urological consequences of self-insertion can be significant and the implications for patients can be serious consequences until death from sepsis [5,6].
We present a case of self-insertion of the needle wrapped with cotton into the urethra for cleaning after masturbation.We review possible motives for insertion of foreign bodies in to the urethra and discuss clinical

DISCUSSION
Self-insertion transurethrally of foreign bodies in the literature has been presented including fishhooks, pencils, electrical cables, metal rods, screws, a knife handle, and pistachio shells [1].However, selfinsertion of foreign bodies in children is very rare [1].Complications of selfinsertion of foreign bodies for the urethra are known as urethral injury, urethrocutaneous fistula, bladder perforation, and renal failure [7][8][9][10].
Foreign bodies in the lower urinary tract can be migration from adjacent sites which may result in trauma.The reasons for insertion of foreign bodies into urethra could be psychiatric, accidental, sexual stimulation, curiosity especially among children, or therapeutic in cases of stricture [11].The case presented here is very interesting.
Cause underlying of self-insertion of the needle into the urethra is very different.
Self-insertion of the needle wrapped with cotton into the urethra for cleaning after masturbation by patient was applied.Needle had escaped into the urethra.
In the presence of a foreign body in the urethra often requires prompt diagnosis and treatment [1,[12][13][14].Definite therapy of urethral foreign bodies aims at complete removal with minimal invasive method and least complications.The most optimal method to remove urethral foreign bodies depends on features of the objects, such as shape, size, location, and mobility in the urethra [1].At the same time, procedures of foreign body removal from the urethra such as meatotomy, cystoscopy, internal or external urethrotomy, suprapubic cystostomy have been described.However, removal of foreign body is usually performed via cystoscopy but may require open surgery [15].Even in infancy it is possible to extract foreign body by transurethral approach.Cystoscopy is minimal invasive technique for retrieval [16].In our case, foreign body in the urethra was removed by cystoscopy.Any complications did not develop.Additionally, cotton residue in the urethra was observed.
Psychiatric evaluation has been advised in all cases of self insertion of foreign bodies, although this has not been universally agreed upon [1,17].Psychiatric control in our case was recommended.

CONFLICT OF INTEREST
None declared.

PUCR
Ped Urol Case Rep presentation, as well as diagnosis and management of such patients.CASE REPORT A 13-year-old boy presented to the emergency department approximately 3 hours after the event with a urethral needle he had self-inserted.The boy was otherwise healthy, without previous medical problems, including psychiatric illness or drug addiction.This was the first time he had ever self-inserted a foreign body in his urethra.The patient said that he was masturbating.Self-insertion of the needle wrapped with cotton into the urethra for cleaning after masturbation by him was applied.Needle had escaped into the urethra.A physical examination was unremarkable.Posteroanterior and lateral pelvic x-ray image demonstrated a straight radiopaque needle inside the urethra (Fig.1,2).The needle was extracted via transurethral route with a urethroscope under general anesthesia.The post-operative course was uneventful and he was discharged home after 24 hours.The patient had a preliminary psychological evaluation.

Fig. 1 .
Fig. 1.Posteroanterior and lateral pelvic radiogram of patient.There is a linear radio-opaque foreign bodies in the region of urethra.