Khat-induced intravesical coiling of a self-inserted urethral serum set: a rare cause of acute urinary retention requiring open bladder surgery

Abstract

BACKGROUND: Foreign bodies within the lower urinary tract are uncommon but clinically significant causes of acute urinary retention and urological emergencies. Self-insertion into the urethra is among the most frequently reported mechanisms and is often associated with psychiatric disorders, intoxication, autoerotic behavior, or altered mental status. Khat (Catha edulis), a widely used psychoactive stimulant in East Africa and the Arabian Peninsula, may contribute to impaired judgment and behavioral disturbances. CASE PRESENTATION: We report a 40-year-old previously healthy man who presented to the emergency department with acute urinary retention and severe suprapubic pain following self-insertion of an intravenous infusion set into the urethra after prolonged khat consumption and transient loss of self-awareness. Physical examination demonstrated suprapubic bladder distension and tenderness. Contrast-enhanced computed tomography revealed a coiled tubular foreign body within the urinary bladder. Cystoscopic evaluation confirmed extensive intravesical coiling of the infusion tubing, making endoscopic retrieval technically difficult and unsafe because of the risk of urethral and bladder injury. Consequently, open cystotomy was successfully performed for complete removal of the foreign body. The patient had an uneventful postoperative recovery and was discharged in stable condition. Psychiatric evaluation and postoperative retrograde urethrography were recommended; however, the patient was lost to follow-up before urethral integrity could be formally assessed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Self-inserted urethral foreign bodies may present as acute urinary retention and can assume complex intravesical configurations that complicate minimally invasive retrieval. Early imaging, prompt urological consultation, and individualized management are essential to prevent urethral trauma, bladder injury, infection, and long-term complications. This case also highlights the potential role of khat-associated behavioral impairment in unusual urological emergencies.