Today's medical mysterie

[George K]

"You've got what in your bladder?"

CASE REPORT
A63-year-old male presented to his urologist with complaints of sudden-onset urinary urgency, pelvic pain, and dysuria with decreased force of his urinary stream. He had had four suspected urinary tract infections in the past 12 months. Prior urine cultures had grown Escherichia coli, and his symptoms had improved following treatment with antibiotics...At cystoscopy, a large calculus (stone) which filled the entire bladder was visualized. A computed tomography (CT) scan of the pelvis was performed to further characterize the calculus.

An open cystolithotomy was performed, and the extracted bladder calculus was submitted to the Metals Laboratory at the Mayo Clinic ...During processing, the core of the calculus was noted to consist of two soft, gelatinous tubular structures resembling a worm. Therefore, the specimen was transferred to the Parasitology Laboratory at the Mayo Clinic in Rochester, MN, for further identification...On longitudinal sectioning, there was an apparent absence of grossly discernible internal structures. This finding, in addition to the lack of expressed eggs and the uniform-appearing gelatinous cut surface, raised suspicion that the specimen was a nonorganic foreign body.

In an effort to further elucidate the nature of the specimen, infrared spectrum (IR) analysis was conducted by comparing sections of the patient specimen to sections of the artificial fishing worm. The IR spectra of the reference artificial fishing worm and the patient sample (foreign body) were indistinguishable, suggesting that the carbon polymers used to create the two samples were virtually identical (Fig. 3).

At the patient's postoperation follow-up appointment, the nature of the foreign body was discussed. He later admitted to his urologist that he had self-inserted an artificial worm into his urethra approximately 3 years earlier. However, he felt certain that it had been removed at that time and not retained in the bladder...

In conclusion, we report an unusual case of a foreign body within the urinary bladder which mimicked a parasitic worm. The nature of the foreign body in this case, an artificial fishing worm, presented a unique challenge to the parasitology laboratory. The specimen was not easily identifiable as a foreign object and in fact was manufactured to simulate a living organism. The fortuitous presence of a similar artificial fishing worm in the laboratory allowed a detailed external and internal comparison as well as side-by-side analysis of polymer structures using infrared spectra. The most likely route of entry was self insertion through the urethra into the bladder by the patient.
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Hey, y'all, pro tip: Don't stick things where they don't belong, especially if you can't get them out again.

[Mik]

Why, oh why, would someone do that? Is this an aberrant sexual behavior I have not previously heard of?

[George K]

@mik said in Today's medical mysterie:

an aberrant sexual behavior I have not previously heard of

Precisely. It's rare, but not unheard of to insert various objects into one's urethra.

Sometimes, they get lost...

[Jolly]

@george-k said in Today's medical mysterie:

@mik said in Today's medical mysterie:

an aberrant sexual behavior I have not previously heard of

Precisely. It's rare, but not unheard of to insert various objects into one's urethra.

Sometimes, they get lost...

Including the plastic ink column of a Bic ink pen. Which, in case you were wondering, produces royal blue urine...

[brenda]

Insert Cats' koala picture here.

Nothing else, just that, and keep your hands to yourself.

[George K]

@brenda said in Today's medical mysterie:

keep your hands to yourself.

Well, that's sort of the problem, isn't it?

[brenda]

@george-k said in Today's medical mysterie:

@brenda said in Today's medical mysterie:

keep your hands to yourself.

Well, that's sort of the problem, isn't it?

And the alternative is worse.

[bachophile]

Can u send me the link of the original case report? I want to pass it on to my urology friends. ( maybe bad choice of verb on my part)

[George K]

@bachophile done.

[taiwan_girl]

@mik said in Today's medical mysterie:

Why, oh why, would someone do that?

Exactly! Ewwwwww