When a 22-year-old male patient presented to doctors at a clinic in Saudi Arabia, he was curiously absent of any symptoms.
We say curiously because the man in question had a very unusual medical issue to divulge – and one you'd reasonably assume would be extremely painful and problematic.
In a remarkable case report, doctors tell the story of a patient who showed up at their medical clinic with a pair of 8-centimetre-long (over 3 inches) hair tweezers stuck inside his urethra: a foreign body he said he had self-inserted into his penis four years previous to his visit.
While no apparent explanation for the lodged tweezers is given in the case report, the physicians note that "foreign bodies are most commonly inserted into the urinary tract by psychiatric, intoxicated, confused, or sexually curious patients".
That said, while people do engage in these extreme insertions, it's not something doctors see often – and in this case the researchers note it's only the the second time ever that a pair of metal forceps like this has been reported in medical literature as the foreign object in question.
X-ray of pelvis showing tweezers in the anterior urethra. (Abouelazayem et al., Urology Case Reports, 2019)
Not that the choice of tweezers in itself is anything particularly special. As the doctors explain, the documented variety of foreign bodies people insert into their genitourinary tract "defies imagination", including fish hooks, screws, wires, wooden sticks, telephone cables, and even pieces of fish.
Once painful-sounding items like these are pushed up far inside the urethra, though, how do you get them out? The 22-year-old's episode reveals one avenue of approach.
When doctors physically examined the man – who denied having any urological symptoms and was able to pass urine normally despite his four-year ordeal – they could feel the "palpable long foreign body from the mid-shaft of the penis to beyond the penoscrotal junction". Subsequent X-rays confirmed the forceps were lodged in the anterior urethra.
The patient was given a general anaesthetic, and while he was under, doctors inserted a cystoscope into his urethra, revealing the closed end of the tweezers embedded in a false passage deep inside the urethra, while the open end was about 7 centimetres (2.8 inches) from the tip of the penis.
Using a squeezing method they call 'external pressure technique', the doctors kept the open end of the tweezers in a shut position, while a separate pair of inserted endoscopic forceps extracted the object, avoiding the need for open surgery to remove the sharp and potentially dangerous implement.
"Open thumb metal forceps [pose] more technical difficulties during endoscopic extraction, and this is because of its sharp open distal ends, which can injure the urethra during removal," the doctors explain in their report.
"This was avoided by using the external pressure technique and skilful endoscopic manipulation to grasp the forceps with its ends closed."
After the procedure was over, the man was able to urinate normally, and he went home. We will most probably never know how he was able to endure having such a large metallic object embedded inside his urethra for so long – but the fact that he did gave the medical team pause.
They recommended to the patient that he undergo a psychiatric evaluation, but the man refused and did not follow up with the clinic's outpatient department after his delicate operation.
Nonetheless, despite the exceptional circumstances of the case, it's possible the duration of the four-year insertion was simply a result of not wanting to disclose the mishap with doctors.
"The most common reason for self-insertion of a foreign body into the male urethra is for autoerotic and sexual gratification, especially during masturbation," the doctors write.
"In the vast majority of cases, the patients feel guilty and humiliated and, therefore, often delay asking for medical help."
The findings are reported in Urology Case Reports.