History of Foreign Bodies in the Genitourinary System There are illustrated cases of foreign bodies inserted into the penis itself or the urethra from at least the 6th century on. Gauthier describes a foreign body applied to the penis in 1755, and Denucé presented 391 cases in 1856. Monton reviewed the literature and found 455 reports and articles in 1916. Almost all societies, every continent, and all genders and ages are included.46 In one of the oddest textbooks of urology that has ever been published, one must rank Wirt Bradley Dakin’s Urological Oddities as one of the most peculiar. He alerts the reader, “All of this material was generously contributed by surgeons and physicians from nearly every country in the world for a period of fifteen years.” This would certainly indicate the magnitude of this problem since it is a snapshot of only a brief period of time. Dakin begins chapter four ominously with his title, Foreign Bodies in the Bladder, Autoeroticism. He presents 212 cases of these foreign objects within the urinary bladder.47 New York State was the most represented populace in this bizarre collection of bladder foreign bodies. There were 35 states and the District of Columbia represented, showing a broad area of those afflicted with the desire to insert things into themselves. There were also cases from Canada, England and New Zealand, with a total of 111 identified male subjects, 61 females and only 40 where the gender was not indicated. Every ethnicity was noted except the Inuits or Eskimos (but three Native Americans were included). Ages ranged from four-year-olds to 76 years.
Objects du jour • chewing gum (there was no mention of flavors but “spearmint” odors were mentioned) • bobby pins or hair pins • glass rods • thermometers • slippery elm and other wood pieces • crayons and candles • gold watch chains Some of the more esoteric items with only a single reported case: a nail file; squirrel’s tail; squirrel’s penis; earthworm; snake (without head); hog’s penis; two snails; a windshield wiper blade; a French fry; 16 gms of carrots; a baby’s rattle; and finally a fetal skeleton. Then there are items for which the volume of material inserted was exceptional: a whole tureen of gravy (coagulated and crystallized); 24 inches of radio wire; three-foot-long leather and metal belt; 18 feet of fishing line (the resulting stone was the size of a baseball); six feet of 26 gauge wire; a three-foot shoelace; 13 ½ feet of string; and a six mm, 109.5 cm long rubber tube. Though Dakin was certainly not the first medical author to discuss the bizarre practice of introducing a foreign object into one’s own urinary bladder, he certainly was the most graphic. In fact, the tradition that he started of highlighting “urologic oddities” has continued at the Annual Meetings of the AUA Western Section as the Round Table Forum. Cystoscopic methods predominated for management in Dakin’s era but open removal was often necessary. Today, a wide range of minimally invasive methods can be used for these rare, “extreme” cases. Percutaneous suprapubic approaches and both laparoscopic and robotic methods to deal with bladder foreign bodies have been described. Michael Moran, MD — McComb, Mississippi
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