Foreign body of the bladder
Jun 20, 2018
Under the foreign body of the bladder, it is customary to imply all kinds of foreign objects that are introduced into the body cavity from the outside.
To foreign bodies of the bladder include hairpins, thermometers, medical tampons, as well as sequestration( torn sections) of bone tissue.If a bladder is injured, a bullet or a fragment of a projectile may be found in its cavity.Contents: How do foreign bodies penetrate the bladder?Clinical manifestations Diagnosis Treatment of patients Complications
How do foreign bodies enter the bladder?
Important: bladder is an unpaired hollow organ that is located in the small pelvis of a person.It refers to the organs of excretory system and serves as a reservoir for urine.With the external environment, it is communicated through the urethra, which is equipped with a circular muscle - the sphincter.
Most often, foreign bodies find themselves in the cavity of the bladder in a retrograde way, that is, they are "pushed" through the urethra.Significantly less often they penetrate through the wall of the organ from nearby tissues.In exceptional cases, some foreign bodies descend into this organ down the ureter.
In some situations, during operations or diagnostic interventions, they are left inadvertently left by medical personnel( in this case, it is often referred to as gauze tampons).
Clinical practice shows that foreign bodies are more often found in women.This is due to the anatomical features of the structure of their body, since the urethra is shorter and has a wider width.
Doctors are considering 4 leading ways of penetration of foreign bodies into the bladder :
- Introduction of the subject by the patient personally.The patient himself can introduce an object from a prank, out of curiosity or masturbation.In rare cases, foreign bodies appear inside the bladder for criminal abortions( at present, this phenomenon is a rarity).
- Foreign body entering the body due to medical errors.With medical error in the cavity remain gauze balls or fragments of ligature, less often - fragments of surgical instruments.
- Fragment hit by a gunshot wound.If there is a gunshot wound, then in the bladder can be like the wounding shells themselves, and clothing particles or fragments of bones.
- Move fragments from nearby organs.Of the nearby pelvic organs, foreign bodies are able to migrate with purulent necrotic phenomena
Clinical manifestations of
Symptoms of foreign objects are dependent on a number of factors, including the method of penetration, its nature, and the duration of the object in the bladder.Of great importance is also the degree of chemical effect on the foreign body of urine.
Symptoms characteristic of the disease include:
- various disorders of urination;
- presence in the urine of the blood( sometimes - in large quantities);
- urinary incontinence;
- acute urinary retention.
Note: reveals abnormally high white blood cell count during urine laboratory tests.
Immediately after penetration of a foreign body, the patient often experiences pain of varying intensity( local character).
If the object has a smooth surface, then it can stay in the cavity of the organ for a long time without leading to urination disorders.In this case, the symptomatology is very similar to the stones in the bladder.Bodies with sharp edges, sooner or later, inevitably injure the walls of the bladder, causing the development of such symptoms as micro- or macrohematuria.
If a secondary infection joins, then development of cystitis is possible.
With a classic history, diagnosis is usually not difficult.It is more difficult to diagnose foreign objects if patients carefully hide their entry into the organ.It is also problematic to find a body that has penetrated the mucous membrane, or if it is inside the formed abscess.
When a vaginal examination of patients reveals that the posterior wall of the bladder is characterized by increased density and painful on palpation.If the patient has a lean physique, then with an empty bladder the foreign body can be determined palpably.
In a male patient, a foreign body is often determined by rectal examination.
The most informative method of instrumental diagnosis is cystoscopy.In the course of this study, it is not difficult to consider a foreign body if the mucosa is not inflamed.
Note : Cystoscopy is problematic if the underlying disease is complicated by cystitis.Inspection is also difficult if the object fills the entire cavity of the organ or the capacity of the bladder is sharply reduced.
Fluoroscopy helps to easily identify surgical instruments that are located in the cavity of the bladder or nearby.
Treatment of patients with bladder foreign objects
The tactics of treating each patient are selected strictly individually.Of course, all foreign objects are to be removed from the bladder.
Subjects that do not produce severe symptoms, as well as causing pain to the patient, are subject to elimination in a planned manner, ie, it is a planned surgical procedure.
The main technique is considered to be the abdominal removal by means of a special operating cystoscope.
Conditions for successful removal of a foreign object from the bladder:
- the object is not fixed;
- body dimensions allow to pass through the urethra, avoiding injuries;
- inflammation of the urethra is either absent or not very pronounced.
All procedures are easier to perform in female patients, in connection with the above-mentioned features of the anatomical structure.Women can undergo intravesical manipulation.
Relatively large bodies are first divided into several parts.Then they are either eliminated endovizikalno, or aspirated( sucked apparatus with a large negative pressure).
Important: If the body is overgrown with urinary salts or is large, it is usually surgically removed.
Usually, complications are caused by pointed foreign bodies that are able not only to penetrate the wall of the bubble, but also to break through it.Injuries of the mucous membrane are the cause of paracystitis, but perforation leads to peritonitis.
If too prolonged stay of the body in the cavity of the organ leads to inflammation of the membrane, cystitis develops.Inflammation can and nearby organs( in particular - the kidneys).In this case, the development of inflammation of the renal pelvis is probably pyelonephritis.
One of the complications is a certain forced position of the patient, in which he can commit an act of urination.
The forecast is regarded as favorable for the timely elimination of the cause, i.e., of a foreign object.
Plisov Vladimir, medical reviewer