Intravesical Foreign Body via a Vesicoperineal Fistula

Male urethral “play” has been described for centuries. There are serious potential complications in this. We present a bizarre case of a variant of such play. A 49-year-old man presented with abdominal pain and incontinence. He had created a “neovagina” at the perineum for self-pleasure. The handle of a toilet brush was placed in the neovagina for self-pleasure but retracted into the bladder via a vesicoperineal fistula. An open cystotomy was performed to remove the foreign body. 1. Introduction The artistic and written description of unusual genitourinary tract activities (UGUA) has been around for several centuries. Participation in such activities has been described across cultures and nations [1]. Contemporary case reports and reviews have focused on the embedment of fluids or foreign objects in the genitalia or placement into the urethra, that is, “urethral play.” Numerous reports have described peculiar objects being placed within the genitourinary tract, for example, battery, pencil, pearl, beads, light bulb, small milk carton, electrical wire, carrot, toy, magnet, dog penis, and a decapitated snake [1–5]. Most often the motivation for UGUA is sexual stimulation, but curiosity, psychological issues, and intoxication have also been linked [2]. The migration of foreign bodies into the bladder from surrounding anatomic structures has been reported, for example, intrauterine device, artificial urinary sphincter, prosthetic sling, vaginal pessary, and nonabsorbable suture [3]. To our knowledge, we present the first case of migration of a foreign body to the bladder from a self-inflicted perineal defect. 2. Case Presentation A 49-year-old man presented to the emergency room with complaints of lower abdominal pain and urinary incontinence. A CT scan was ordered (Figure 1). On urologic examination, a 6？cm self-induced incision was discovered longitudinally along the perineal raphe. Six years previously he had sharply incised his perineal raphe to create a “vagina.” He indicated that the impetus for self-mutilation was feelings of guilt that he had associated with his sexual abuse of a family member over twenty years before. However, he placed foreign objects in the created space in order to derive sexual pleasure. Two weeks previously, influenced by alcohol intoxication, he had inserted the handle of a toilet brush and was unable to retrieve it. Figure 1: CT scan of the pelvis, demonstrating the toilet brush and surrounding fluid. There is a left-sided hydronephrosis (right, lower picture). He was taken to the operating room where a further examination