Case presentation
A woman in her thirties was referred to our center with a complaint of difficulty in removing an FB inserted into her urinary bladder through the urethra. She also complained of lower abdominal pain and admitted that she inserted the FB by herself through her urethra for sexual gratification. She had no history of illness, including a psychiatric one. Her blood sample test revealed an almost normal but slightly elevated C-reactive protein of 0.21 mg/dl. Cystoscopy was immediately performed in the outpatient care unit, which revealed a rod-shaped FB stuck into her left bladder wall (Figure 1a). Pelvic computed tomography (CT) revealed that FB had completely penetrated the left bladder wall, but its tip did not appear intraperitoneally (Figure 1b-d). She was diagnosed with bladder FB complicated by bladder perforation. She underwent a surgical exploration instead of transurethral FB excision because the presence of peritoneal injury was not excluded. The Retzius cavity was expanded and a cystostomy was made through a lower abdominal Pfannenstiel incision. The FB turned out to be a 9.5-cm long plastic Asian traditional hair stick called kanzashi in Japanese (Figure 2a). The peritoneum was confirmed to be intact, consistent with the CT diagnosis, although the hair stick penetrated the bladder wall (Figure 2b). The bladder wall was fixed by suturing in two layers. Her postoperative course was uneventful, and the urethral catheter was removed 6 days postoperatively after a cystography confirmed no leakage. She was recommended to stop the urethral sounding after her discharge. We also suggested that she use medical intermittent catheters instead of kanzashi as a tool for sounding If she could not stop it. However, she denied our suggestion, and our postoperative followup was terminated.