Urethral foreign bodies are uncommon but represent a challenging urologic emergency. Reported cases involve various objects and mechanisms of insertion, including self-insertion for sexual stimulation, iatrogenic causes, assault, or migration.  Optimal management should aim for minimal invasiveness, reduced long-term complications, and early recovery.  We present a case of successful removal of a large urethral foreign body using a combined transurethral and percutaneous endoscopic approach.

A 39-year-old healthy male presented to the emergency department with urinary retention and lower abdominal pain six hours after self-inserting a silicone rod into his urethra. Examination revealed a distended bladder and a palpable foreign body in the bulbar urethra. A suprapubic tube was inserted under ultrasound guidance for decompression. Pelvic X-ray failed to visualize the object. The patient underwent cystoscopy with a trial of endoscopic extraction although multiple trials for transurethral extraction failed. The object was advanced into the bladder and removed through the suprapubic tract via nephroscope after dilation of the tract using balloon dilation and advancing a working sheath.

The large conical silicone rod was successfully extracted through the percutaneous tract without the need for open surgery. The tract was closed with a single absorbable suture, and a Foley catheter was left for five days. The postoperative course was uneventful, with normal voiding upon catheter removal. The patient was scheduled for follow-up urethrogram but did not return for later evaluation.

Combined percutaneous and transurethral cystoscopy provides an effective, minimally invasive option for the removal of large or impacted urethral foreign bodies. This technique avoids open surgery, and promotes rapid recovery. Patients with self-insertion behavior may have poor follow-up compliance, highlighting the need for proper counseling and education.