An Unusual Foreign Body in the Urinary Bladder Mimicking a Parasitic Worm

Abstract

We report an unusual case of a foreign body removed from the urinary bladder of a 63-year-old male which mimicked a parasitic worm. The foreign body was identified as an artificial fishing worm by morphological comparison to a similar commercially produced product and by infrared spectrum analysis. CASE REPORTA 63-year-old male presented to his urologist with complaints of sudden-onset urinary urgency, pelvic pain, and dysuria with decreased force of his urinary stream. He had had four suspected urinary tract infections in the past 12 months. Prior urine cultures had grown Escherichia coli, and his symptoms had improved following treatment with antibiotics. A physical examination, including genital and prostate examinations, revealed no abnormalities. A urine test strip was positive for blood, leukocytes, trace protein, and nitrite. An ultrasound postvoid residual procedure performed in the office demonstrated minimal residual urine but revealed calcifications within the bladder. His urine was sent for culture, and he was prescribed sulfamethoxazole and trimethoprim double strength and scheduled for an outpatient cystoscopy.At cystoscopy, a large calculus which filled the entire bladder was visualized. A computed tomography (CT) scan of the pelvis was performed to further characterize the calculus (Fig. 1). The CT scan demonstrated a large spiral-shaped tubular calcific structure, measuring up to 7.0 by 5.2 cm in overall dimensions, within the urinary bladder. Mild thickening of the bladder wall and a streak artifact due to left hip arthroplasty were noted.An open cystolithotomy was performed, and the extracted bladder calculus was submitted to the Metals Laboratory at the Mayo Clinic in Rochester, MN, for bladder stone analysis. Analysis of the 8.7 g of crystals removed from the specimen demonstrated a composition of 90% ammonium urate and 10% uric acid. During processing, the core of the calculus was noted to consist of two soft, gelatinous tubular structures resembling a worm. Therefore, the specimen was transferred to the Parasitology Laboratory at the Mayo Clinic in Rochester, MN, for further identification. Upon receipt, the specimen was noted to be yellow-green to black and cylindrical and to have annular circumferential ridges. It had previously been bisected; the reconstructed object measured approximately 16 cm in total length by 1.3 cm in greatest width.On cut sectioning, the specimen revealed a gelatinous cut surface from which a minute amount of clear fluid could be expressed. Microscopic examination of touch preparations obtained from the cut surface and the expressed fluid revealed occasional sloughed urothelial cells and numerous polymorphic bacteria and yeasts. No helminth eggs were detected.On longitudinal sectioning, there was an apparent absence of grossly discernible internal structures. This finding, in addition to the lack of expressed eggs and the uniform-appearing gelatinous cut surface, raised suspicion that the specimen was a nonorganic foreign body. Fortuitously present in the labora...

Case Study: Dioctophyma renale Infection in Mice, Incidental Finding During Experimental Studies

“…Structure greatly resemble the morphology of the larvae of Dioctophyma renale had been reported in the renal pelvis of two mice, in the third one, cross section of the parasitic larvae were reported to be encysted in the renal fat close from the renal pelvis. Analysis of all available literature revealed that parasite was always accidentally diagnosed as the case in our report (Schmitt et al, 2012;Katafigiotis et al, 2013). According to many animal/ human cases, the infection can be explained by indiscriminate eating habits of these animals (Kommers et al, 1999) that occurred by eating infected worms or paratenic hosts as fish, crayfish or frogs in which the larvae become encapsulated in the tissue.…”

An earphone wire inside the urinary bladder: A case report and comprehensive literature review of genitourinary polyembolokoilamania

“…After the primary and secondary screenings were conducted as shown in Fig. 5 , we obtained a total of 17 relevant case reports reporting self-insertion of foreign bodies into the urethra and bladder [3 , 4 , 6 , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] . The details and characteristics of each report are shown in Table 1 .…”

“…The objects reported varied from inorganic to organic objects. Two of the most interesting objects reported consist of 4 kidney beans and an object resembling a worm with an encrustation [6 , 12] . Most reports consist of tubular objects, including cables similar to the earphone wire in this case report.…”

“…The main concern involving patients with self-inserted foreign bodies is their late admittance due to embarrassment or guilt. Severe complications, such as stone formation, recurrent UTI, urinary retention, and necrotic tissue were reported [1 , 12 , 15 , 23] . More severe complications may occur due to dangerous corrosive substances like batteries as reported by Bedi et al [16] .…”

“…Schmitt et al. initially thought that the foreign body in the patient was a parasitic worm, however, upon extraction, it was found to be an inorganic object mimicking the shape of a worm [12] . Thus, to fully visualize the object cystoscopy is necessary.…”