Intravesical foreign bodies in pediatric: A case report highlighting the critical role of psychosocial assessment and intervention

Abstract

A 12-year-old female presented with lower abdominal pain and hematuria following the self-insertion of a pencil into her bladder. Imaging revealed a 10.2 cm radiopaque object, which was removed intact via cystoscopy. Postoperative recovery was uneventful, and psychiatric evaluation diagnosed mild depression, highlighting the need for integrated psychosocial intervention. This case underscores the critical importance of a multidisciplinary approach that combines medical and psychosocial care in the management of intravesical foreign bodies, particularly in pediatric populations. Proactive measures, including mental health education and early psychosocial support, are essential for prevention and recurrence mitigation.

Highlights

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A rare report of pediatric patient with intravesical foreign body, detailing specific challenges and management strategies.
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The essential role of psychosocial assessment and intervention in managing pediatric patients who self-insert foreign body, illustrating the intersection of mental health and urological care.
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Clinical characteristics, treatment approaches, and outcomes for a distinct case contributing valuable data to the limited literature.
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Successful removal of foreign body via cystoscopy, demonstrating the effectiveness of minimally invasive surgical techniques in pediatric urology.
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An integrated treatment approach including psychological evaluation and support, aimed at improving patient outcomes and preventing recurrence.

1 Introduction

Foreign bodies in the bladder or urethra present a multifaceted clinical challenge necessitating a comprehensive understanding of both physiological and psychological dimensions. These cases typically result from iatrogenic injuries, self-insertion, sexual abuse, or migration from adjacent anatomical structures. Although such incidents are documented across all age groups, occurrences in pediatric populations are notably rare and often complicated by underlying psychosocial factors.

Extensive medical literature highlights a diverse range of foreign objects retrieved from the bladder, spanning common household items to medical devices. Clinical manifestations frequently include urinary tract infections, discomfort, and hematuria, though physical examination may reveal no overt abnormalities. Obtaining an accurate medical history is particularly challenging in cases involving self-insertion, often due to embarrassment or reluctance to disclose sensitive information. Diagnostic strategies typically employ imaging modalities such as radiography for radiopaque objects and ultrasonography for others.

Technological advancements in endoscopic procedures have transformed management approaches, minimizing the need for open surgical interventions. However, this challenge extends beyond object removal. These cases often involve complex psychological dynamics, including fear of embarrassment, leading to delayed presentation and various psychosocial vulnerabilities that require attention.

This report underscores the critical importance of combining psychosocial assessments with medical management to optimize patient outcomes, adhering to the SCARE criteria.

2 Case presentation

A 12-year-old female with a Body Mass Index (BMI) of 27.4 presented to the emergency department following the insertion of a pencil into her urinary tract approximately 5 h earlier. Despite presenting with hematuria, the patient maintained urinary function and reported lower abdominal pain rated 5 on the Visual Analog Scale (VAS). She denied any prior incidents of foreign-body insertion. Physical examination and vital signs were unremarkable. Imaging revealed a hyperechoic lesion on ultrasonography ( Fig. 1 ) and a 10.2 cm radiopaque foreign body within the pelvic cavity on radiography ( Fig. 2 ).

The patient underwent urethrocystoscopy for foreign body removal. Using a 19 Fr cystoscope with a 0-degree lens, the pencil was grasped with forceps at the tip ( Fig. 3 ) and extracted intact with biopsy forceps. The removed object measured 10.2 cm in length and 0.6 cm in width ( Fig. 4 ). The bladder wall appeared intact, and a 14 Fr Foley catheter was inserted post-procedure. Perioperative care included parenteral analgesics and prophylactic antibiotics. A subsequent psychiatric evaluation revealed vulnerabilities, peer pressure, body image concerns, and risk-taking behaviors factors that concluded the mild depression assessment, warranting the initiation of fluoxetine (10 mg daily) and lorazepam (0.5 mg daily).