AUA Summit - Sounding


It is not at all unusual for an urologist to find himself—cystoscope in hand—confronting a foreign body that has been inserted into the urethra and sometimes, lost inside the bladder! In some cases, symptoms may not present for years and, in others, the damage can be quick and severe, leading to urethritis, hematuria, urinary tract infection, acute cystitis, and urinary retention.5 In rare cases, anti-peristaltic action can allow small, thin objects—such as straw and cat hair—to be pushed up the urinary tract, into a ureter, and eventually into the ureteropelvic junction of the kidney.5 In such cases, flank pain, fever, and general malaise occur, often concurrent with infection and possible septicemia.5 An entire arsenal of treatment options, medical expertise, and creativity are needed to remove the foreign bodies—which can range from pens & pencils, to knotted wire, to paraffin crayons, to live animals—but what compels a person to intentionally insert foreign bodies into the genitourinary track? 3,5

The motivations behind insertion are many and just as variable as the foreign bodies themselves. Chewing gum and candle grease are commonly inserted into the male urethra as a means of contraception.3,5 In one instance, a patient inserted a dry haricot bean into his urethra, as a means to prevent incontinence using the ball valve technique.5 Mental illness has also been implicated in foreign body insertion, particularly mental retardation, obsessive compulsive disorder, and borderline personality disorder.4,5 In some patients, particularly prisoners and mental patients, self-insertion has been used to garner attention or move units, while in others, it has been used as a form of personal punishment and a means to commit suicide.4,5 In children, the insertion of foreign bodies is usually associated with curiosity, but as the internet has become more accessible to younger individuals, imitation of adult behaviors has also played a role.2,5,7

Yet the most common reason for self-insertion is erotic in nature—allowing for urethral stimulation during masturbatory practices—and thus, the practice often develops into a life-long habit.4,5 6  Those who use household items for urethral stimulation are therefore at high risk for losing the foreign bodies inside themselves and all the associated complications. Unfortunately, the shame and humiliation prevent many from visiting an urologist until years have passed and unbearable symptoms have developed.5 For this reason, ‘sounds’ have become popular among those who enjoy urethral stimulation. Historically, ‘sounding’ has been used to dilate urethral strictures, but in recent years, sounds have become a commercially available sex toy used for urethral “play.”6 This allows one to participate in a relatively safe manner, although damage to the urethral mucosa, urinary tract infections, and prostatitis are still considerable risks.1, 6

Kayla M. Smith
M.D. Candidate, Class of 2017

Link Dr. Jonathan Goddard’s great piece in Urology Times Things in a Place They Should Not Be!

The William P. Didusch Center has its version from our 2015 exhibit on Extreme Urology: Practice on the Edge!