Intrauterine device embedded into the bladder wall with stone formation: laparoscopic removal is a minimally invasive alternative to open surgery

Shin, Dong Gil; Kim, Tae Nam; Lee, Wan

doi:10.1007/s00192-011-1632-8

Cited by 44 publications

(62 citation statements)

References 5 publications

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“…However, IUD may cause complications such as unwanted pregnancy, abortion, pelvic infection, uterine or bowel perforation, migration to adjacent organs and vesicouterine fistula [1][2][3]. Uterine perforation rates were reported between 1/2500 and 1/350 in various studies [1,2,4,5]. However, the true incidence might be higher because of unreported asymptomatic cases [6].…”

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confidence: 99%

“…Spontaneous migration of IUD has been tried to be explained by several mechanisms such as iatrogenic perforation of the uterus, spontaneous uterine or involuntary bladder contractions, intestinal peristalsis, and peritoneal fluid motion [1,5,6]. Among the factors that increase the risk of uterine perforation are IUD application by inexperienced medical practitioners, uterine wall fragility related to multiparty, uterine atrophy, hypoestrogenemia during postpartum and lactation periods, adhesions due to previous operations, vaginal tissue damage created by speculum, history of a recent abortion, and congenital uterine anomalies [1][2][3]6].…”

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confidence: 99%

“…Urinary system imaging is necessary to any woman who had recurrent urinary tract infections [5]. In these circumstances, uterine perforation should be suspected: when women with IUD had urinary symptoms or bladder stone, the IUD was not in the uterine cavity on ultrasound, and the strings of the IUD were not seen at the visual inspection of the cervix [5,7].…”

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confidence: 99%

“…In these circumstances, uterine perforation should be suspected: when women with IUD had urinary symptoms or bladder stone, the IUD was not in the uterine cavity on ultrasound, and the strings of the IUD were not seen at the visual inspection of the cervix [5,7]. Diagnostic methods for a vanishing IUD are X-ray film, ultrasound, intravenous pyelography, CT, and cystoscopy [1].…”

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confidence: 99%

“…Open surgery may be required in cases of large stone formation and failing to treat partial penetration to the bladder wall with endoscopic methods [5]. Although a therapeutic approach to asymptomatic uterine perforation is controversial, copper-clad IUDs should be removed because of the inflammatory reaction and eventual adhesion they make [2,4,5].…”

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confidence: 99%

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Intravesical Migration of Intrauterine Device Mimicking Bladder Stone on Radiologic Imaging: A Case Report

Yahşi

Aktaş²,

Erbay³

et al. 2014

Indian J Surg

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Due to its high cost-effectiveness, intrauterine device (IUD) is one of the widely used contraception methods worldwide. Intravesical migration of an IUD via perforation of the uterus and bladder is very rare. Endoscopic approach is recommended in the treatment, but open surgery may also be needed rarely. In this report, we present the case of a 37-yearold female who was misdiagnosed radiologically with bladder stone, but later on, it was understood that an IUD migrated to the bladder and resulted in stone formation. Laser lithotripsy was performed, and the migrated IUD was unearthed. Removal of the IUD with cystoscopic forceps was unsuccessful. Postoperative pelvic computed tomography revealed that a part of the IUD was outside the bladder. At the next operation session, laparoscopic removal of the IUD was applied. The patient was followed up for 5 days with a Foley catheter and discharged after performing cystography, assuring us that the bladder contours were normal.Keywords Bladder . Bladder stone . Endoscopic surgical procedures . Intrauterine device migrations Case HistoryA 37-year-old female was admitted to our urology outpatient clinic with complaints of suprapubic pain, polyuria, and urgency for the past 8 months. From her medical history, we have been informed that despite administration of an intrauterine device (IUD) 6 years ago, she had ectopic pregnancy 4 years ago and therefore she was applied with laparoscopic salpingectomy in a tertiary health-care center, and doctors told her they removed the IUD at the same operation. Her family history was unremarkable and physical examination was normal. Abundant leukocytes, erythrocytes, and crystals were detected at urinalysis. An opacity of 1.5×2 cm in size was viewed in the pelvic region of the urinary tract X-ray. It was reported as a bladder stone at pelvic ultrasonography. Cystoscopic stone fragmentation was planned. However, at cystoscopic examination, it appeared that the opacity which was radiologically considered bladder stone was indeed an intravesical encrusted foreign body entering the bladder lumen from the posterior wall (Fig. 1). Laser lithotripsy was performed and the migrated IUD was unearthed. Removal of the IUD with cystoscopic forceps was attempted, but the IUD was stuck firmly to the bladder wall. Postoperative pelvic computed tomography (CT) revealed that about 1 cm of the IUD was outside the bladder (Fig. 2). At the next operation session, laparoscopic removal of the IUD that was not associated with the uterus anymore was applied. The patient was followed up for 5 days with a Foley catheter, and hematuria was not developed within this early postoperative period. The patient was discharged after performing cystography, assuring us that the bladder contours were normal. DiscussionIUD is a contraceptive method that is widely used worldwide because of its efficacy, reliability, economy, and

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Intravesical Migration of Intrauterine Device Mimicking Bladder Stone on Radiologic Imaging: A Case Report

Yahşi

Aktaş²,

Erbay³

et al. 2014

Indian J Surg

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Intravesical migration of a Chinese intrauterine device and secondary stone formation: diagnostic investigation and laparoscopic management

Liu

Zhang

2015

Int Urogynecol J

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Intravesical migration and secondary stone formation are rare complications of intrauterine devices (IUD) and 47 cases have been reported in the English-language literature since 1974. However, only one such case was managed purely by laparoscopy [1]. The authors present another case in which a Chinese IUD (AiMu MCu) partially migrated to the bladder and was complicated by bladder stone formation, which was successfully managed by laparoscopy under the joint efforts of urologists and gynecologists.A 35-year-old woman (gravida 1, para 1), in whom an AiMu MCu IUD had been inserted 10 years earlier, had been experiencing intermittent episodes of irritative voiding symptoms and gross hematuria for 3 years. She had been treated empirically for urinary tract infection with oral antibiotic therapy several times without further investigation. Urinalysis showed leukocyturia and hematuria. Physical examination was normal. Abdominal plain X-ray showed a displaced Vshaped IUD with a surrounding hyperdense mass in the pelvis (Fig. 1a). Pelvic CT showed that the IUD was partly intrauterine and partly intravesical with stone formation (Fig. 1b). Cystoscopy revealed an IUD penetrating the posterior bladder wall with calculus formation (Fig. 1c). The IUD and stone were successfully removed by laparoscopy (Figs. 2, 3a). A urethral catheter was retained for 2 weeks and the recovery was uneventful.The AiMu MCu (Fig. 3b) is a new Chinese IUD and very popular in China. However, it accounts for nearly one-third (30.5 %; 72 out of 236) of ectopic IUDs [2]. The present case reminds the readers that this type of IUD, which is rarely used outside China, can cause uterine perforation. Persistent lower urinary tract symptoms in women with IUD should raise the suspicion of intravesical migration [3]. We also stress the importance of the cooperation of urologists and gynecologists to work together for such patients. Laparoscopy is a minimally invasive alternative to open surgery in the management of this condition [1].

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Successful removal of an intrauterine device perforating the uterus and the bladder with the aid of a transurethral nephroscope

et al. 2018

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This video demonstrates a rare case of an IUD that perforated both the bladder and the uterine walls and created a nidus for stone formation in the bladder. The surgical technique involved in removing the stone and extracting the IUD is a new approach to treating this problem. It is suspected that this specific surgical intervention may also help to minimize the formation of a larger vesico-uterine fistula by decreasing the extent of trauma potentially created when extracting the IUD. However, this supposition merits further study.

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Intrauterine device embedded into the bladder wall with stone formation: laparoscopic removal is a minimally invasive alternative to open surgery

Cited by 44 publications

References 5 publications

Intravesical Migration of Intrauterine Device Mimicking Bladder Stone on Radiologic Imaging: A Case Report

Intravesical Migration of Intrauterine Device Mimicking Bladder Stone on Radiologic Imaging: A Case Report

Intravesical migration of a Chinese intrauterine device and secondary stone formation: diagnostic investigation and laparoscopic management

Successful removal of an intrauterine device perforating the uterus and the bladder with the aid of a transurethral nephroscope

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