Fishing in the OR: A Stepwise Technique for Safe Urethral Fishhook Removal

Urethral foreign bodies present unique challenges in clinical practice, particularly in pediatric patients. Fishhooks pose specific technical difficulties due to their barbed design. We present the first reported endoscopic method for atraumatic fishhook removal from a pediatric urethra. A 15-year-old male presented after a suicide attempt via potassium chloride (KCl) tablet ingestion. Imaging incidentally revealed a fishhook in his prostatic urethra. On further inquiry, the patient attested to placing a fishhook in his urethra with the hook bend first. A 14 French adolescent cystoscope was inserted into the patient's urethra. The fishhook was wedged in the prostatic urethra, preventing direct retrograde removal without hooking prostatic tissue. We employed an “advance and flip” technique: The bend of the hook was grasped with a 5 French grasper and advanced atraumatically into the bladder. The hook was flipped 180 degrees, angling the point of the hook towards the center of the urethral lumen and away from the scope, preventing urethral trauma during removal. Under direct cystoscopic vision, the fishhook was removed atraumatically. The urethra was again inspected and noted to have no injury. The patient tolerated endoscopic removal of a fishhook after repositioning of the hook within the bladder. Post-operatively, he was able to void without dysuria or hematuria and was instructed to avoid placing objects in his urethra. To our knowledge, this is the first case report describing endoscopic removal of a urethral fishhook in a pediatric patient.