The occurrence of foreign bodies (FB) in the urogenital tract is indeed quite rare in clinical practice, especially in pediatric patients. FBs are more common in girls aged 4–9, while in boys, they are more prevalent in adolescents. FBs can consist of various substances such as magnetic beads, needles, hairpins, pencils, wires, button batteries, cotton swabs, etc. [7–9]. These FBs can be self-inserted, inserted by others, iatrogenic, migrated from adjacent organs, or a result of penetrating trauma [10–11]. In this study, all 30 cases involved self-inserted foreign bodies. The reasons for self-insertion differ significantly between adults and children. Adults may be influenced by sexual behavior, psychological disorders, self-harm, artistic expression, or substance abuse [12–13]. In pediatric cases, it is often due to curiosity, imitative behavior, play, emotional stress, self-exploration, or may indicate underlying mental health issues [14–15]. The insertion of foreign bodies into the urogenital tract, regardless of age, poses extremely high risks and can lead to significant physical injuries. If these foreign bodies remain in the body for an extended period, they may cause various serious complications [16]. Therefore, early diagnosis and treatment are crucial for patients with urogenital tract foreign bodies. Due to the diverse sizes, shapes, natures, and locations of urogenital tract foreign bodies, their clinical manifestations vary. Bladder foreign bodies typically result in spasmodic abdominal pain, hematuria, a sense of incomplete urination, and urinary interruption. Urethral foreign bodies are often accompanied by penile pain, urgency, dysuria, hematuria, and difficulty urinating [17–18]. Vaginal foreign bodies may cause increased abnormal genital secretions or genital bleeding, and studies suggest they are a rare cause of increased genital secretions and bleeding in pre-adolescent girls [19]. The prolonged presence of foreign bodies can lead to the formation of stones or the generation of granulation tissue around the foreign body, resulting in recurrent urogenital tract infections, fistula formation, and even sepsis [20].
When diagnosing foreign bodies (FB) in the urogenital tract, it is necessary to consider the patient's medical history, symptoms, clinical examinations, and imaging studies comprehensively. Sometimes, further specialized examinations may be required to ensure an accurate diagnosis. Young children, due to a lack of knowledge, fear, or embarrassment, often find it challenging to provide a clear history of foreign body implantation (FB), adding to the diagnostic difficulty [21]. When dealing with pediatric patients, it is especially important to use patient and sensitive communication methods to better understand their situations. Key information includes the nature, size, length, quantity, and time of insertion of the foreign body to facilitate better diagnosis and treatment [22].Sharp or corrosive foreign bodies may cause mucosal rupture, leading to bleeding and painful symptoms, making early detection and diagnosis relatively easier. However, for some smaller, smooth, or disc-shaped foreign bodies, it may be challenging to cause noticeable symptoms in the early stages. Additionally, children may hide their medical history due to shame, making early detection and diagnosis even more challenging. In our study, seven cases had foreign bodies for more than one month, four cases for over six months, with the longest duration being one year. Therefore, in such cases, doctors need to conduct a more careful assessment and inquiry, relying on detailed medical history collection and more sensitive clinical observation to ensure timely detection and management.The preferred diagnostic auxiliary examination is ultrasound (B-mode), which is a non-invasive, radiation-free, and cost-effective method, considered safe and comfortable for pediatric patients [23]. A study indicated that ultrasound examination has an overall sensitivity of 81% in diagnosing urogenital FB [24]. In the case of urogenital foreign bodies, ultrasound can provide information about the location, size, nature of the foreign body, and the presence of other abnormalities in the urogenital system [25].Abdominal plain radiography is more intuitive for non-radio-opaque foreign bodies, allowing direct visualization of the shape and size of the foreign body. Its specificity for detecting abnormalities reaches up to 91% and is usually sufficient for locating and identifying metal and non-radio-opaque FB [24, 26]. However, abdominal plain radiography is unreliable for detecting radio-opaque FB and exposes children to radiation. Ultrasonography is highly useful in diagnosing radio-opaque substances [27]. In our study, 26 cases of foreign bodies were considered preoperatively through ultrasound and abdominal plain radiography, with a diagnostic rate of 86.7%. CT scans can provide better soft tissue images and higher diagnostic value when ultrasound and abdominal plain radiography cannot determine the presence or displacement of foreign bodies [28].
For children with a clinically confirmed diagnosis or a high suspicion of urogenital system foreign bodies, surgical treatment should be considered early after thorough preoperative preparation to minimize damage to the urogenital tract [12]. The clear goal of the surgery is to achieve the removal of foreign bodies (FBs) with minimal complications [14]. The treatment strategy for urogenital FBs depends on various factors, including the shape, nature, location, and size of the foreign body [29]. Specific methods include manual removal, endoscopic treatment, laparoscopic treatment, open surgery, etc. [30–31]. For small anterior urethral foreign bodies with smooth and blunt surfaces, lubricating the urethra with vaseline oil and pushing the foreign body towards the distal urethra with vascular forceps can be attempted. If unsuccessful, surgical treatment should be considered [32]. For foreign bodies in the posterior urethra, bladder, and vagina, endoscopic removal is usually the preferred treatment method [33–34]. Endoscopy has high value in both the diagnosis and treatment of FBs. This non-invasive surgical method, using cystoscopy or vaginoscopy, allows direct visualization of the foreign body and attempts to extract it with graspers [35]. Compared to open surgery, this endoscopic approach typically reduces patient discomfort, lowers the risk of postoperative complications, and shortens the recovery time. Due to the relatively narrow urethra in children, if the foreign body in the posterior urethra is large, it can be pushed into the bladder for removal [36]. When endoscopic treatment fails, open surgery is usually adopted, including suprapubic cystotomy for intravesical foreign bodies and external urethrotomy for foreign bodies lodged in the penile urethra. In our study, for larger FBs or those with significant adhesion to bladder tissues, we used pneumovesicum laparoscopy to extract the foreign bodies. This minimally invasive surgical approach is associated with less trauma, minimal bleeding, and faster recovery compared to traditional methods. We successfully applied this method in two cases in our study. In this research, two cases involved mercury thermometers, which were discovered during cystoscopy in the urethra-bladder region. Due to the risk of rupture, we did not push them into the bladder but instead used a perineal urethral incision to remove the thermometer. Additionally, four cases involved sewing needles, and cystoscopy revealed that the foreign bodies had penetrated the urethra and migrated towards the perineum. To safely extract these foreign bodies and avoid further damage to the urethra, we utilized a perineal small incision and successfully located and removed the needle tips. For urethral-bladder foreign bodies, especially sharp objects, entry into the urethra can cause urethral injury. To prevent and reduce the likelihood of urethral stricture, we extended the duration of catheterization postoperatively. Especially in cases where partially sharp foreign bodies were found to have penetrated the urethra, causing urethral injury, we further prolonged the catheter retention time. Through postoperative follow-up, we have not observed the occurrence of urethral stricture, indicating that prolonging catheter retention time may help reduce the risk of postoperative urethral stricture. In comparison to the urethra, the vagina has a relatively short and wide anatomical structure, providing a broader space for endoscopic operations [37]. We chose to use a vaginoscopic foreign body forceps to successfully remove the 14 cases of vaginal foreign bodies in this study, and the entire process proceeded smoothly.
To prevent incidents of urogenital foreign bodies in children, caregivers can take the following preventive measures: Firstly, they should closely supervise children, especially young ones, and guide their curiosity correctly to prevent accidents. Secondly, caregivers should ensure that potentially dangerous items are stored out of reach of children. Additionally, educating children about body safety and knowledge of hazardous items is crucial. Finally, educating caregivers about the risks of urogenital foreign bodies in children and possible symptoms is essential so that they can take prompt action and seek medical help rather than attempting self-treatment.
This study has some limitations, including a single-center retrospective design and a relatively small sample size, which may not comprehensively represent the population of children with urogenital foreign bodies. Long-term follow-up data are limited and do not provide detailed information about the long-term health and complication development of patients. Despite these limitations, the study still provides valuable insights for healthcare professionals to enhance the diagnosis and treatment of urogenital foreign bodies in children, improving the quality of life for patients. Future research could address these limitations by expanding the sample size, delving into the characteristics and treatment outcomes of patients in different age groups, and conducting longer-term follow-ups for a more comprehensive understanding and management of this rare but significant clinical issue.