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Paper text:
over the past decade , reports in the literature of self - inserted intra - vesical and intra - urethral foreign bodies have increased [ 13 ] .
typically , objects are self - inserted via the urethra as the result of erotic impulses , psychometric problems , sexual curiosity or sexual practice while intoxicated .
diagnosis of these foreign bodies can be done by a combination of clinical history , physical examination and radiological studies of the patient .
the removal of the foreign body is determined by its size , location , shape and mobility . in most cases , minimally invasive procedures such as endoscopic removal
however , in some cases , major open surgery is mandatory if the foreign bodies can not be removed by endoscopic procedure or further injuries are expected as a result of the endoscopic procedures .
we present the case of a 41-year - old lady who self - referred to the emergency department for lower abdominal pain associated with dysuria .
the patient had self - inserted 24 hr previously , without being constrained , a crochet needle into her urethra out of sexual curiosity . on examination ,
the patient was clinically stable and her abdomen was soft but mildly tender suprapubically , without evidence of guarding or peritonism .
an x - ray of her pelvis showed a 3-cm radiopaque foreign body ( fig  1 ) .
the patient underwent an examination under anaesthesia and a diagnostic rigid cystoscopy was performed which identified a 9-cm crochet needle in the bladder , with the sharp end lodged in the mucosa of the proximal urethra ( fig  2 ) .
there was evidence of debris in the bladder but no signs of bleeding or bladder wall injury or perforation .
the foreign body was removed successfully with graspers and bladder washouts were undertaken to clear the debris from the bladder . the procedure and
she was discharged on the following day and she was prescribed oral antibiotics for 5 days . unfortunately , the patient failed to attend the follow - up appointment . 

case reports on this subject have been published from the early days of modern medical publishing .
typical circumstances that lead to self - insertion of foreign bodies are erotic impulses , mental illness or borderline personality disorder , sexual curiosity and play during intoxication . however , the most common motive associated with foreign bodies in the genitourinary tract is sexual or erotic in nature , such as masturbation and other forms of sexual gratification or variations .
patients thereafter usually feel embarrassed and tend to avoid seeking immediate medical help and may make several attempts to remove the objects , resulting in further migration and injury .
regarding the psychoanalytical aspect , there are a few theories for self - insertion of devices for sexual gratification .
kenney 's theory states that the initiating event is an accidentally discovered pleasurable stimulation of the urethra , which is followed by repetition of this action using objects of unknown danger , driven by a particular psychological predisposition to sexual gratification [ 3 , 4 ] .
other authors consider these acts as an indication of an impulsive behaviour which is self - punishing in nature and that may aggravate to suicide and recommend a psychiatric evaluation of all these patients [ 4 , 5 ] . in our case , the patient was counselled to undergo a psychiatric consultation , but she refused .
various complications can occur as a direct result of intra - vesical foreign bodies , if left untreated .
more severe complications may arise in the long term , such as chronic or recurrent urinary tract infection , urinary retention , calcification , hydronephrosis , posterior urethral injury , obstructive uropathy , vesico - vaginal fistula , squamous cell carcinoma and sepsis  and so early recognition and treatment is necessary .
the diagnosis can be done by thorough clinical history , physical examination and imagistic studies .
radiological evaluation is necessary for diagnostic purposes in order to determine the size , location and number of foreign bodies prior to planning therapeutic intervention .
plain x - ray or ultrasonography usually provides sufficient information required to proceed with the intervention ; computer tomography scan is rarely used .
definitive management of foreign bodies aims to provide complete removal of the foreign body with minimal complications
because of the anatomy of the female urethra , foreign bodies in the bladder are usually removed endoscopically .
delayed complications such as urethral stricture may occur  and so close follow - up is recommended if possible .
reported an incidence of urethral stricture of only 5% , but most of the patients fail to return for their follow - up visits , and thus the true incidence of urethral stricture may be higher   and so this potential complication should be discussed with the patient .
it should be emphasized that it is the insertion of the foreign body , not its retrieval , which is the primary risk factor for stricture disease .
foreign bodies into the urethra inserted for autoerotic stimulation is a rather rare urological emergency .
endoscopic manipulation is the preferred first - line treatment for intra - vesical foreign bodies and if unsuccessful , open procedures may be necessary .
radiological evaluation is necessary to determine the exact size , number and nature of foreign bodies .
psychiatric consultation should be done to prevent further attempts of insertion of other foreign bodies in the urinary tract .
self - insertion of foreign bodies into the urethra and urinary bladder for autoerotic stimulation is a rather rare urological emergency condition . 
 we present a case of 41-year - old lady who self - inserted a crochet needle into the urethra for sexual pleasure , which was successfully retrieved during examination under general anaesthetic and endoscopic bladder evaluation . 
 foreign bodies in the urinary bladder are rarely encountered yet represent a urological challenge that requires prompt management in view of possible sequellae if left untreated .