Cystoscopic removal of a migrated intrauterine device to the bladder; a case report

Abstract

Background An intrauterine device (IUD) is a well-accepted means of reversible contraception. Migration of IUD to the bladder through partial or complete perforation has been rarely reported. This phenomenon could be strongly associated with history of prior cesarean sections (C-section) or early insertion of the device in the postpartum period. Case presentation In this study, a case of copper IUD migration through cesarean scar defect is presented, in such a way that was successfully managed by cystoscopic removal. A 31-year-old female with a history of lower urinary symptoms referred to the clinic for her secondary infertility work-up. A copper IUD outside the uterus in the bladder was found using hysterosalpingraphy. A plain abdominal radiography also confirmed the presence of a T-shaped IUD in the pelvis. According to ultrasound, the copper IUD was partly in the bladder lumen and within the bladder wall. The patient had a history of an intrauterine device insertion eight years ago followingher second cesarean delivery. Three years later, her IUD was expelled, and another copper IUD was inserted. Thesecond copper IUD was alsoremoved while she decided to be pregnant. The patient finally underwent a hysteroscopic cystoscopy. The intrauterine device with its short arms embedded in the bladder wall was successfully extracted through the urethra. Conclusions IUD insertion seems to be more challenging in women with prior uterine incisions and requires more attention. Cystoscopic removal should be considered as a safe and effective minimally invasive approach tomanage a migrated intrauterine device in the bladder.

Management of Intrauterine Device Migrated into the Bladder: A Case Report and Literature Review

“…The removal of the fully migrated IUD from the bladder is most often performed during cystoscopy [13], without difficulty in the cases seen early as in our case. In some cases, the removal is preceded by lithotripsy in the case of a calcified IUD.…”

“…However, cystoscopy remains essential for a complete evaluation of the bladder. It may reveal the presence or absence of a foreign body such as calculus and also help in determining if the migration is partial or complete into the bladder [13]. A blue methylene test or cystography is often useful to rule out fistula.…”

Removal of Complete Spontaneous Migration of an Intrauterine Contraceptive Device to the Bladder by Cystoscopy

“…A similar case reported by Vahdat et al noted that no stones were found in the bladder from an IUCD that had migrated there and been present for five years. However, there was a risk factor from previous scar defects that occurred, which resulted in bladder perforation [ 5 ].…”

“…When an IUCD becomes displaced or migrates, it can lead to severe complications such as bowel perforation, hydronephrosis, and even renal failure. The occurrence of an IUCD translocating into the bladder is an uncommon event that may be linked to the lower urinary tract symptoms, formation of vesicouterine fistula, development of bladder stones, or bladder perforation [ 5 ]. Endoscopic treatments and open surgical removal are two therapeutic options for an intrauterine device in the bladder [ 6 ].…”

An Unusual Cause of Vesical Calculi

“…All migrated Cu-IUCDs require removal, which can be achieved by different routes. Most of the intravesical Cu-IUCDs can be managed endoscopically [9][10]. Cystoscopy helps in planning the optimal management and must be performed before embarking on removal.…”