Open Access

ARTICLE

Management of genitourinary foreign bodies in a predominantly incarcerated population

Tyler J. Maiers¹, David J. Abramowitz¹, Raymond Pominville¹, Ajay A. Myneni², Katia Noyes^2,3, John J. Bodkin III^1,4

1 Department of Urology, Buffalo General Medical Center, Buffalo, New York, USA
2 University at Buffalo Surgical Outcomes and Research, Department of Surgery, Jacobs Institute, Buffalo, New York, USA
3 Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
4 Western New York Urology Associates, Cheektowaga, New York, USA
Address correspondence to Dr. Tyler J. Maiers, Department of Urology, Buffalo General Medical Center, 100 High Street, Suite B280, Buffalo, NY 14203 USA

Canadian Journal of Urology 2020, 27(6), 10444-10449.

Abstract

Introduction: Genitourinary foreign body (FB) insertion is a rare occurrence. Commonly reported reasons for insertion include autoeroticism and intoxication; however, psychiatric illness is thought to contribute in most cases. In the incarcerated population, malingering plays a prominent role. We examined clinical patient characteristics and management patterns for cases of genitourinary FB insertion and sought to identify risk factors for recidivism.
Materials and methods: A retrospective review was performed of all patients presenting to a tertiary trauma center with a genitourinary FB between January 2001-June 2019. Patient demographics, presentation, workup, and management were reviewed. Bivariate and multivariate statistical analyses were performed.
Results: Patients were primarily young (33 years old, range: 21-93), male (92%), incarcerated (67%), and had at least one psychiatric diagnosis (71%). Concomitant FB ingestion was present in 56 (41.5%) encounters. Risk factors for repeat FB insertion included incarceration (100.0% versus 51.5%, ρ = < 0.01), psychiatric comorbidity (100.0% versus 51.5%, ρ = < 0.01), and other concomitant FB insertion/ingestion (68.7% versus 18.2%, ρ = < 0.01). Common methods of FB extraction included flexible cystoscopy (33.8%), extrinsic pressure (21.0%), rigid cystoscopy (12.8%), and open surgery (8.1%). Fifty-three (39.2%) encounters required anesthesia and 64 (47.4%) encounters required admission.
Conclusions: Genitourinary FBs are usually removed via endoscopic or minimally invasive extraction techniques and the majority are located within the anterior urethra. Special consideration should be given to patients with psychiatric comorbidity, concomitant FB insertion/ingestion, or those presenting from a correctional facility as these characteristics are associated with repeat insertion attempts.

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