Transurethral insertion of a vaginal contraceptive suppository into the urinary bladder
Mayersak, J.S.; Viviano, C.J.
Wisconsin Medical Journal 93(1): 13-15
1994
ISSN/ISBN: 0043-6542 PMID: 8160479 Document Number: 287905
Patients usually come to the emergency room within 2 hours of accidentally inserting a vaginal contraceptive suppository into the urinary bladder. Usually, there is a history of intoxication of the patient associated with the misplacement of the suppository. The patient complains of severe urgency, stranguria, intensive suprapubic pain, and hematuria. The pH of the spermicide is 3.35. For Conceptrol, the pH of the vaginal suppository is 4.5. The acidic nature of the suppositories contributes directly to the severe chemical cystitis encountered. Physical examination may reveal marked urethral edema and urethral pain. Urological evaluation demonstrates a marked reduction in the capacity of the urinary bladder with uninhibited bladder contractions. These patients have a severe hemorrhagic cystitis with pseudopolyp formation and marked elevation of the mucosal surfaces of the urinary bladder. A 3-way catheter should be inserted into the urinary bladder, and the bladder emptied. Irrigation with an alkaline solution should be initiated because of the acidic nature of the suppositories to assist in the reduction of the symptoms and duration of the chemical cystitis. Broad spectrum antibiotic coverage should be instituted along with antispasmodic therapy for the uninhibited bladder contractions. The use of intravenous steroids at high doses is recommended. The patient should be hospitalized, and an oral steroid tapering dose with prednisone should be started. Urological evaluation should be performed because of submucosal bladder hemorrhage and blood clot formation in the bladder. Significant hemorrhage from the bladder and possibly permanent bladder damage can occur. Because a significant absorption of the nonoxynol-9 can occur via the bladder mucosa, appropriate liver and renal function studies should be obtained for the treatment of the patient. There was a significant reduction in the capacity of the urinary bladder reported in some cases of nonoxynol-9 suppository insertion that persisted for up to 6 weeks.