Foreign bodies in the bladder are quite common disorders of the lower urinary tract. Most of them originate from various surgical procedures but rarely are a consequence of transurethral self-insertion, as a result of sexual curiosity or autoerotic stimulation. From 2006 to 2015, in our center the prevalence of this condition was 0.05%, but only six (0.02%) of the cases were due to sexual curiosity. Transurethral endoscopic procedures as well as open or laparoscopic, or single-port techniques, have been successfully applied to remove bladder foreign bodies. We present the case of using the transvesical laparoendoscopic single-port surgery (T-LESS) for removal of an unusual metallic foreign body.

In October 2015, we carried out the T-LESS access on a 45-year old man to remove an erotic urethral device with a long metallic cable that migrated into and spontaneously knotted in the bladder.

The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (Tri-Port+, Olympus, Germany) via a 1.2-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The metallic device and metallic wire were removed intact through the port after disconnecting the rings of the Tri-Port+. The skin incision was closed with two stitches. A Foley catheter was left for four days.

The operation lasted 25 minutes. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. The patient was discharged within 8 hours of surgery. During a four-week follow-up the patient reported no irritative or obstructive symptoms. Laboratory examination results were all within normal range. The patient refused to undergo psychiatric consultation.

Although transurethral procedures are sufficient for most bladder foreign bodies removal, in some cases an open approach should be applied. The T-LESS procedure can be considered as a valuable option for such patients due to its minimal invasiveness, short hospital stay, and fast recovery time.