Unusual cases part 4

Do not put stuff in your urethra

A 14-year-old Chinese boy placed some magnetic beads in his urethra and thought he could get them out by himself. After attempting to remove them by inserting even more magnetic beads, he began bleeding and finally told a family member what he had done. He was in shock on arrival to a local hospital. At surgery, the beads were removed.

The same urologist had taken care of another boy who had inserted magnetic beads in his urethra. A bout of abdominal pain 70 days later caused him to be taken to the hospital where he eventually told the doctors about the beads. The urologist was able to inflate the bladder with air and remove all the beads via the urethra.

Urinary retention on a long flight

Many physicians have responded to the call, “Is there a doctor on board?” But an incident aboard a China Southern Airlines flight from Guangzhou to New York two weeks ago took it to another level.

The story comes from the South China Morning Post. Some 10 hours into the flight, an elderly man with a history of an enlarged prostate had abdominal distention, pain, and sweating. Two surgeons responded to the call and made the diagnosis of urinary retention. Because New York was 6 hours away, they decided they needed to empty his bladder at once.

With supplies at hand—tape, oxygen tubing, straws, and a needle from a syringe—they successfully punctured the bladder through the abdominal wall with the patient lying on the floor in the plane’s back galley.

They were not satisfied with the rate of urine flow through the small needle. One of the doctors decided to suck the urine into his mouth and spit it into an empty wine bottle. It took about 30 minutes to withdraw almost a liter of urine. The patient was advised to see a physician in New York.

The surgeon said, “If we had not dealt with the situation in time, the patient’s life would have been at risk.” Some scoffed at this, but although spontaneous rupture of the bladder is rare, fatalities have been reported when the diagnosis is delayed or missed.

Below is a photograph taken during the procedure. A brief video is available here.

When I tweeted a link to this story, I received many comments ranging from revulsion to admiration. The most interesting comment came from @MeritPtahDO :

“Interestingly I had to cath a patient on a 13.5 hour flight a few days ago. The emergency kit on Qatar [Airways] had 4 sterile straight caths in it. No lube though and with BPH maybe it wouldn’t have worked but I hope the airline gets caths into their kit. At least for long-hauls.”

So that’s two recent cases of in-flight urinary retention. With Qantas now testing a 19-hour nonstop flight from New York to Sydney, maybe all long-haul airlines should have urinary catheters, lubrication, drainage bags, and sterile gloves in their medical kits.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chair and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.