# Polyembolokoilamania and Beyond: A Clinical Case Series on Urological Foreign Bodies of Diverse Aetiologies and Management Strategies

## TL;DR

This paper presents three unique cases of foreign bodies in the urinary tract, highlighting the challenges in diagnosis and the need for tailored treatment approaches.

## Contribution

The paper contributes a clinical case series showcasing diverse causes and management strategies for urological foreign bodies.

## Key findings

- Foreign bodies in urology can arise from self-insertion, trauma, or disease-related migration.
- Treatment requires individualized approaches, ranging from endoscopic to surgical interventions.
- Multidisciplinary care improves outcomes, especially in complex behavioral or systemic cases.

## Abstract

Urological foreign bodies, while uncommon, represent a clinically significant challenge due to their diverse aetiologies. They often lead to complex diagnostic dilemmas and require tailored, sometimes multidisciplinary, therapeutic interventions. These may result from self-insertion, penetrating trauma, or transorganic migration, and are associated with major complications such as infection, obstruction, and fistula formation. This series of cases attempts to demonstrate the varied aetiologies, diagnostic difficulties, and treatment approaches of urological foreign bodies seen in a tertiary referral centre.

There are three case presentations, each illustrating a unique mechanism. The first case was a 22-year-old man who self-inserted an electric tube casing into the urethra for autoerotic stimulation - a case of polyembolokoilamania. The second case was a 52-year-old man with a chronic discharging sinus secondary to a retained wooden splinter from penetrating trauma. The third case involved a 64-year-old man with Crohn's disease, in whom undissolved mesalamine tablets migrated into the bladder via an enterovesical fistula and presented as vesical calculi.

All patients underwent definitive management tailored to the underlying aetiology. Case 1 was treated endoscopically and was referred for psychiatric assessment. Case 2 needed open surgical exploration for the removal of an organic foreign body. Case 3 had a laparotomy with bowel resection and bladder repair. Postoperative course was uneventful in all three patients, and there was no recurrence at six-month follow-up.

Timely diagnosis of urological foreign bodies is dependent on a high index of suspicion, coupled with imaging. Individualised treatment, from endoscopic to open surgery - coupled with multidisciplinary input, particularly in behaviourally or systemically based pathology - guarantees the best patient outcome.