Endoscopic Management of Transurethrally Inserted Magnetic Beads

doi:10.1016/j.urology.2012.10.031

Urology

Volume 81, Issue 2, February 2013, Pages e13-e14

https://doi.org/10.1016/j.urology.2012.10.031 Get rights and content

Transurethral insertion of foreign bodies into the urinary bladder is uncommon in children. We report an 11-year-old boy who presented with hematuria and difficulty voiding secondary to numerous magnetic beads lodged in the urinary bladder and posterior urethra.

Section snippets

Case Report

A healthy 11-year-old boy presented to the emergency room with acute onset of gross hematuria and difficulty voiding. The patient believed he had recently ingested 5 magnetic beads by mouth and developed abdominal pain the next day. He reported having then inserted additional beads into the urethra, believing he could retrieve the previously ingested beads in this fashion. On presentation, abdominopelvic radiography demonstrated numerous beads in the urinary bladder but none in the

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Cited by (13)

Enteroenteric fistulae after ingestion of multiple magnets in children
2022, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
In 2020 Holtz et al. advised screening of foreign bodies with a plain X-ray of the abdomen and chest in disabled children with a history of recent abdominal pain prior to MRI [43] because they found severe artifacts on brain MRI as result of multiple magnet ingestion which are detected later on by abdominal plain x-ray [43,44]. The transurethral insertion of high-power magnetic beads is a rare but significant hazard [45–47]. In 2014, Rafael stated that cystostomy must be undertaken if the transurethral attempt to remove the beads fails and recommended, however, that pediatric urologists become familiar with the reported experience [45].
Infants and young children explore objects by putting them in the mouth. Although most swallowed foreign bodies pass spontaneously through the gastrointestinal tract without causing harm, some of them are potentially dangerous and may be lethal.
Five children (3boys and 2girls) have swallowed multiple high strength and powerful rare earth element Neodymium magnets. Their ages ranged between (nine months to six-year-old). Three cases were subjected to open and two for laparoscopic exploration (one of them converted to open).
multiple complicated enteroenteric fistulae in three cases and multiple perforation of small intestine in two cases. Resection anastomosis was done for one case and simple closure of small bowel perforations for other four cases. Post operative course was uneventful for all patients and discharged in a good general condition.
General practitioners should be aware of the danger and complications of Neodymium magnetic beads ingestion by children. Early endoscopic removal is recommended if the patient presents immediately after ingestion. Parents awareness through media is required to abandon magnet balls in houses and where children can ingest those dangerous balls.
Experience of pediatric urogenital tract inserted objects: 10-year single-center study
2019, Journal of Pediatric Urology
Citation Excerpt :
Considering the diameter and magnet of magnetic balls, endoscopic technology sometimes could be performed instead of open surgery. Pediatric cystourethroscope with a stone basket and grasping forceps was once used to retrieve magnetic spherical balls from the urethra successfully [22]. Chung et al [23] reported to remove degraded magnetic spheres by Hartmann ear forceps, which might be related to magnetic degradation.
Urogenital tract foreign bodies (FBs) have been rarely reported in children, and the management is still challenging.
The aim of this study is to review a 10-year experience with urogenital tract FBs in a single center.
The authors reviewed the records of children suspected with urogenital tract FBs and first admitted to the hospital, including demographic characteristics, presenting symptoms, methods of diagnosis, and management. The authors compared the surgery strategies in different locations of FBs and age, and the locations of FBs in different age groups.
Two hundred and thirty-nine cases were reviewed, and 188 were confirmed to retain urogenital tract FBs (150 girls and 38 boys). The number of the patients increased progressively in the last 10 years and mainly concentrated in spring and summer in the last 4 years. The peak ages were 3–5 years old and 9–13 years old. General anesthesia surgeries were performed on 20 patients (Fig. 1). Vagina FBs were more likely to require day surgery, whereas bladder FBs required surgery in hospital. Patients younger than 6 years were more likely to be girls with vagina FBs, and patients older than 11 years were more likely to be boys with bladder FBs.
Urogenital tract FBs in children is a great challenge. As the vagina is shorter and wider than the urethra, girls with vagina FBs are usually treated by day surgery and adolescent boys of urethra FBs are treated by hospital surgery. Misdiagnosis may occur when patients conceal FBs insert history, have severe urinary tract infections, or have previous surgery history. Ultrasonography helps to reduce misdiagnosis. FBs should be taken into consideration when patients have new symptoms after hypospadias repair, and postoperative changes of hypospadias repair, such as urinary calculi, have been excluded. Appropriate surgery techniques, based on the size, nature, and location of FBs, should be performed for complete removal of FBs with minimal complications to reduce secondary injury. Sharp FBs could be migrated among the digestive system, urogenital system, and deep pelvic. If the procedure is difficult, patients with a stable needle can be conservatively managed with close follow-up. Nevertheless, symptomatic patients should be treated actively.
The awareness of potential severity of pediatric urogenital tract FBs should be raised. Appropriate toys and timely sex education help prevent children from urogenital tract FBs insertion. Selecting appropriate techniques for particular situations is the best way to reduce secondary injury, especially for cases with migrated FBs (needles), magnetic FBs, and postoperative FBs.
Urethral Foreign Bodies: Clinical Presentation and Management
2016, Urology
Citation Excerpt :
In the Cook County Hospital experience, only 35 discrete episodes among 27 patients were observed over 15 years. As a result, the literature regarding this entity is relatively scant, and consists mainly of case reports1-7 and limited case series.9,11 In our review of our institutional experience with this entity, we identified features that may be associated with urethral foreign body insertion, and described management of different presentations.
To review a single institution's 15-year experience with urethral foreign bodies, including evaluation, clinical findings, and treatment.
In total, 27 patients comprising 35 episodes of inserted urethral foreign bodies were reviewed at Cook County Hospital between 2000 and 2015. Retrospective chart review was performed to describe the clinical presentation, rationale for insertion, management, recidivism, and sequelae.
Median patient age was 26 (range 12-60). Twenty-six patients (97 %) were male, 1 was female (3%). Items inserted included pieces of plastic forks, spoons, metal screws and aluminum, pieces of cardboard or paper, staples, writing utensils such as pens and pencils, as well as coaxial cable and spray foam sealant. Reported reasons for insertion were self-stimulation, erectile enhancement, and attention seeking. Presenting symptoms included dysuria, gross hematuria, urinary retention, urinary tract infection, and penile discharge. The most common technique for removal was manual extraction with extrinsic pressure (n = 19, 54%). Other methods include endoscopic retrieval (n = 8, 23%), open cystotomy (n = 1, 3%), and voiding to expel the foreign body (n = 7, 20%). Postremoval complications included urinary tract infection (n = 7), sepsis (n = 4), urethral false passage (n = 5), laceration (n = 5), and stricture (n = 1).
We present the largest single-institutional series of urethral foreign bodies to date. Urethral foreign body insertion is a relatively rare occurrence and, commonly, is a recurrent behavior. Urethral trauma related to foreign body insertion is associated with significant risk of infection and urethral injury with long-term sequelae.
Urethral foreign body: Removal of degraded magnetic spheres using hartmann ear forceps
2014, Urology
Citation Excerpt :
Magnets involving the lower urinary tract are therefore rare. Several reports describe the retrieval of buckyballs from the lower urinary tract (predominantly the bladder) using either endoscopic or open techniques.5-7 We describe a complex urethral case that required a combined approach of both urethrotomy and cystoscopy.
Lower urinary tract foreign bodies have been reported in both children and adults. It is helpful for urologists to review foreign body case reports to become familiar with alternative approaches for removal that may prove helpful during challenging cases. To our knowledge, we describe for the first time a degraded rare-earth magnet within the body and use of Hartmann ear forceps to remove a foreign body from the urethra under cystoscopic guidance through a limited urethrotomy.
High-strength neodymium magnetic beads: A rare foreign body in the bladder of an adolescent
2014, Urology Case Reports
Citation Excerpt :
During his 1-day hospitalization, the patient had a preliminary psychological evaluation. We reviewed the available literature finding only a pediatric case report of an 11-year-old boy who inserted several magnetic beads into his bladder, which were extracted individually with a stone basket and grasping forceps.1 The authors did not mention if the magnets were high-strength neodymium magnetic beads.
Laparoscopic extraction of a urethral self-inflicted needle from pelvis in a boy: a case report
2023, Frontiers in Pediatrics

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: Financial Disclosure: The authors declare that they have no relevant financial interests.

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Images in Clinical UrologyEndoscopic Management of Transurethrally Inserted Magnetic Beads

Section snippets

Case Report

J Urol

Urology

Lancet

Renal insufficiency secondary to delayed presentation of a retained foreign body

Can J Urol

Images in Clinical Urology
Endoscopic Management of Transurethrally Inserted Magnetic Beads