In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

Abstract

To investigate about the opinions of gynecologists regarding the in-office hysteroscopic removal of retained or fragmented intrauterine device (IUD) without anesthesia. An online survey was made available to gynecologists who routinely performed in-office hysteroscopy. Five areas of interest were analyzed: average number of hysteroscopic procedures performed without anesthesia, availability on their local market of the different types of hormonal and non-hormonal IUDs, reasons for the hysteroscopic removal of the IUD, types of IUDs that were more commonly found retained or fragmented and, overall difficulty of the hysteroscopic removal. A total of 419 surgeons voluntarily responded the survey, of which 19 were excluded for not performing in-office hysteroscopy. The most commonly available IUD was the Levonorgestrel-based Mirena (Bayer Healthcare, Germany) or similar, (399/400, 99.7%), followed by Copper T (Paragard, CooperSurgical INC, United States) (397/400, 99.2%), Multiload (234/400, 58.5%) and Jaydess (Bayer Healthcare, Germany) (227/400, 56.7%). The intracavitary retention of the IUD with (44.5%, 178/400) and without (42.2%, 169/400) visible strings accounted as the most common reason for undergoing hysteroscopic IUD removal. Copper T IUD was the most common intracavitary retained (297/400, 74.2%) as well as fragmented device (236/400, 59.9%). The in-office hysteroscopic removal of the IUD was considered an easy procedure by almost all the operators (386/400, 96.5%). In-office hysteroscopy without anesthesia is seen as a feasible and easy approach to remove retained or fragmented IUDs inside the uterine cavity or cervical canal. While the Levonorgestrel-based IUD is the most commercialized, Copper T IUDs are the most commonly found retained or fragmented.

The contradictive findings between ultrasound, hysteroscopy and cytokines in women with nonhormonal IUDs suffering from menorrhagia: a prospective study

“…A cross-sectional survey published by Carugno et al [ 7 ], showed that hysteroscopic procedures performed for IUD removal were mostly because of retention or fragmentation without mentioning of embedding, which strengthen our findings.…”

Risk factors for intrauterine device embedment in postmenopausal women: an analysis of 731 participants undergoing hysteroscopy

“…If deemed safe, the IUD can be removed with a lower chance of subsequent perforation or complications. In addition, hysteroscopy aids in determining the need for additional laparoscopy to ensure a safe approach for removal 14 . At our facility, hysteroscopic IUD removal with Alligator forceps or a ring hook was attempted in the operating room for all postmenopausal women.…”

“…Diagnostic procedures, including bimanual pelvic examinations, ultrasonography, dilation and curettage, and/or laparoscopy, are commonly performed in women with IUD-related disorders 13 . Hysteroscopy with or without anesthesia is reportedly a feasible method of retrieving or repositioning an IUD, especially in cases in which the strings are not visible or fragmented pieces are located within the uterine cavity or cervical canal 14-16 . The visual dimensions offered by hysteroscopy improve diagnostic accuracy and minimize the limitations associated with other diagnostic procedures, such as blind curettage and hysterosalpingography (HSG).…”

An Overview of Outpatient Hysteroscopy

“…The most common indication for diagnostic hysteroscopy is abnormal uterine bleeding, infertility and recurrent pregnancy loss [7][8][9]. Common procedures include endometrial polypectomy [10], submucous fibroids removal [11], also endometrial ablation [12], removal of lost intrauterine devices [13]. Hysteroscopy afford to remove uterine adhesions [14].…”