Case Study: Foreign Body In Bladder

Mrs JC was referred by the GP to the Consultant Obstetrician (Oncologist) with the following history:

74 years old, with complains of unstable bladder, urge incontinence and nocturia, with no evidence of haematuria or GSI as per previous investigations.

On consultation with the Gynaecologist there was no significant prolapse and in view of the long standing urgency (6 years) plan was made for Cystoscopy +- Cystodistension+- Biopsy.

Her past history:
Gynaecology: Total abdominal hysterectomy and bilateral salphingo-oophorectomy after diagnosis of borderline adenocarcinoma after ovarian cystectomy and completed follow up in 2002.

Medical:
Angina: On clopidogrel and GTN PRN
Depression and anxiety attacks: Not on medication
Drug overdose and alcohol dependence

Social History:
Lives aloneRetiredAlcohol dependent

Cystoscopy was performed on 9th April 2008 and she was found to have large pale white to yellow coloured polypoidal mass in the bladder. On closer examination it was became clear that the white material was calcification and on removing that away ,it became clear that they were three strands of suture material which were not part of a knot but just freely hanging in the bladder.

Intrigued we re-explored the details of the previous surgery and on conversation with the previous consultant in charge of her case, we realised that the suture material was nylon which was in vogue 10 years ago used for closure of rectus sheath during gynaecology surgery.

It also became clear why we should not and do not use that material any more. It also explained the reason for her symptoms for such a long time!

She has been referred for operative cystoscopy to the urologists and is currently on medication for the urgency in the interim.

To introduce Nylon and clarify the reasons for the reduced popularity of the same, following information will be useful to the readers.

Nylon: This is a polyamide polymer suture material available in monofilament (Ethilon/Monosof) and braided (Nurolon/Surgilon) forms. The elasticity of this material makes it useful in retention and skin closure. Nylon is quite pliable, especially when moist. Of note, a pre moistened form is available for cosmetic plastic surgery. The braided forms are coated with silicone. Nylon suture has good handling characteristics, although its memory tends to return the material to its original straight form. Nylon has 81% tensile strength at 1 year, 72% at 2 years, and 66% at 11 years. The material is stronger than silk suture and elicits minimal acute inflammatory reaction. Nylon is hydrolyzed slowly, but remaining suture material is stable at 2 years, due to gradual encapsulation by fibrous connective tissue.

The handling of non absorbable monofilament suture materials is difficult for many surgeons because of the stiffness of the material. Nylon is typical in this group and its use results in a mild suture reaction, and fibroblastic and capillary proliferation occurs earlier in the sutured area in comparison to other materials (Okamoto et al., 1990. Edema is one of the features of the early phases of wound healing, and results in an increased volume of the injured tissue. The use of rigid suture materials such as nylon would result in additional trauma for the tissue.

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