title: Late migration of a toothpick into the bladder: initial presentation with urosepsis and hydronephrosis.
abstract: OBJECTIVE
  Migration of objects into the urinary tract from the digestive tract has been described. Our objective is to report the case of a patient with urosepsis and late migration of toothpick from the gastrointestinal tract into the bladder.
  
  
  METHODS
  A 78 y/o male patient with uro-sepsis and hydronephrosis was admitted. The initial suspected etiological cause was obstructive ureteral lithiasis. CT scan showed hydronephrosis and a possible ureteral stone. However, a femoral catheter was in place near the toothpick location, which jeopardized the detection of the foreign body. Antibiotic therapy and placement of a ureteral stent were performed. Once infection subsided, ureteroscopy was carried out showing a slight extrinsic compression of the distal ureter. The patient was readmitted with urinary infection. New imaging studies showed a foreign body in the bladder, which was not evident previously. Cystoscopy showed a toothpick penetrating the bladder and it was removed.
  
  
  RESULTS
  Retrospectively, we interpreted that the foreign body perforated the gastrointestinal tract, migrated to the retroperitoneum and caused upper urinary tract obstruction by inflammatory reaction in the periureteral tissues. Once infection was solved, ureteral manipulation by ureteroscopy may have caused the toothpick migration into the bladder.
  
  
  CONCLUSIONS
  Migration of foreign bodies from the gastrointestinal tract into the bladder occurs rarely. They clinically present as a complicated urinary tract infection. Imaging studies make the diagnosis, and a high level of suspicion is required.
authors: Urology Department, Mateu Orfila General Hospital, Mahón, Menorca, Spain. agarciasegui@gmail.com
authors: Alejandro
authors: A
authors: Garcia-Segui
authors: Eduardo
authors: E
authors: Bercowsky
authors: Ignacio
authors: I
authors: Gómez-Fernández
authors: Ramón
authors: R
authors: Gibernau
authors: Miguel
authors: M
authors: Gascón Mir
mesh_terms: D000368:Aged; D003558:Cystoscopy; D004724:Endoscopy; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology*; D008297:Male; D010300:Parkinson Disease / Q000150:complications; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D014552:Urinary Tract Infections / Q000209:etiology*; D013520:Urologic Surgical Procedures