Syed Saeed Abidi, Mohd Aslam, Tariq Mahmood Khan.
Textiloma of the Urinary Bladder - An Effortless Way Out of a Complex Scenario.
Pak J Surg Jan ;28(2):145-9.

Objective: To highlight the adaptation in the use of stone punch lithotrite for endoscopic management of textiloma of the urinary bladder. Study Design: Experimental, clinical practice study. Place and study duration: Th is study was conducted in Karachi Medical and Dental College, Abbasi Shaheed Hospital Karachi, from January 2009 to December 2010. Methodology: Th is study includes cases of forgott en swabs within the urinary bladder. All cases were managed endoscopically. Stone punch was used as a grasper through 27 French Resectoscope sheath. Th e studied variables include, referral hospital status, qualifi cation of primary operator, operative details including documentation of bladder trauma and repair, patients complaints, provisional diagnosis, urine detailed report and culture, ultrasound and X-ray fi ndings. Results: Total three cases were managed in two years. One male patient from general surgical unit and two females from gynecology department. Two cases were operated in teaching hospitals, while one obstetric case was operated in a private non-teaching hospital. All cases were operated by qualifi ed surgeons. Detailed operative notes were present in two cases that include documentation of bladder trauma and repair, while in one hysterectomy case that was operated in a teaching hospital, neither patient and her family nor operative notes of the procedure mentioned any bladder injury during surgery. Clinical presentation of all cases were diff erent and provisional diagnosis was incorrect. All laboratory tests were negative for any forgott en swab in the bladder. Ultrasound and plain X ray reports were not indicative of any cott on sponge. Urine detail report confi rmed persistent pyuria and haematuria, and urine culture was positive in all cases. Textiloma of the bladder was an incidental fi nding in all cases. Surgical swabs were found while performing cystoscopy. All cases were managed endoscopically. Swabs were removed with the help of stone punch via 27 sheath resectoscope, Th ere was no trauma to urethra, and patients were discharged within 24 hours. Conclusion: Forgott en swab in the bladder is an extremely rare phenomena. It can happen by any person, irrespective of experience and qualifi cation. Its diagnosis in majority is incidental. By simple adaptation in the use of endoscopic instruments, one can easily avoid re exploration of patients and its treatment related morbidity and mortality

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