An American man who found it painful to urinate and ejaculate has had a bullet removed from his bladder 18 years after getting shot.
A Urology Case Reports article on the case, written by medical professionals Joanna Marantidis and Grace Biggs, says the 42-year-old Connecticut man experienced stabbing pain whenever he ejaculated or used the toilet for a year.
According to the journal article, the patient had been shot in the bladder in 1990. The inaccessible position of the bullet meant it was retained inside the man's genitourinary system.
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The bullet eventually migrated, eroding through the bladder wall and becoming lodged inside the organ. A bladder stone formed around the foreign object, encrusting its surface.
The patient presented his symptoms to the urology office and the fragment has been successfully removed, measuring approximately three by 2.5 centimetres.
"While this is not the first case of bullet fragmentation migrating into the bladder, our patient had an 18-year delay from the time of the GSW [gunshot wound] to the time of urinary symptoms," said the article.
"To our knowledge, this represents one of the longest reported delays in patient presentation."
Marantidis and Biggs concluded that clinicians should have considered removing the bullet in 1990 to ultimately prevent "long-term complications associated with bullet migration".
Consultant urologist Dr Rich Viney told the Daily Mail the case is unusual, but not unique.
"When confronted with a foreign object the body will initially wall it off with scar tissue," he explained. "It will then slowly propel it towards the nearest external surface to expel it from the body - normally back along the entry route taken by the object."
Dr Viney agreed that in the 42-year-old's case, the bullet was too large to pass through the urethra, meaning it remained inside the organ until surface crystals formed a bladder stone.
According to the journal, the bullet was handed over to police following its removal.