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

Cystoscopic Management of the Intravesical Migration of an Intrauterine Device Complicated by Bladder Stone Formation: A Video Case Report

Intrauterine device (IUD) migration is a rare complication of IUD placement. The current case is of a 32-year-old lady who presented with pregnancy following IUD failure. Subsequent imaging revealed intravesical migration of the IUD. A cystoscopic evaluation revealed a bladder stone (encrusted IUD), with no breach in the bladder mucosa and no evidence of a fistulous opening. The encrustation was broken down, and an intact IUD was retrieved. This video report shows the management of a migrated IUD complicated by a bladder stone using cystoscopy that not only allowed for a combined diagnostic and therapeutic approach to the extraction of the IUD but also provided information regarding the involvement of the bladder wall and confirmed no extravesical protrusion of the device.

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

Intrauterine contraceptive devices (IUCD) are widely used as a reversible method of contraception. Although uterine perforation caused by an IUCD is rare, in some cases, the device may migrate to the pelvic/abdominal cavity or nearby structures. When the IUCD migrate to the bladder, it can lead to various symptoms. These include pain or discomfort in the lower abdomen, difficulties or pain during urination, frequent urinary tract infections, and the development of bladder stones. This article presents a case report of a 24-year-old woman with an intrauterine contraceptive device (IUCD) that had migrated completely into the bladder. She had an IUCD inserted by a midwife four years earlier and became pregnant a year later, unaware of the IUCD's presence. She later presented with lower abdominal pain, hematuria, and dysuria three months before being admitted to our hospital. Imaging confirmed the intravesical location of the IUCD. She underwent successful cystoscopy treatment to remove the migrated IUCD. Prompt diagnosis and appropriate management are crucial in preventing complications and improving patient outcomes. Clinicians should be aware of this potential complication and consider it when patients present with symptoms or complications after IUCD insertion. Regular monitoring and timely intervention can help detect and address IUCD migration effectively.

Migrated Intravesical Intrauterine Contraceptive Devices: A Case Series and a Suggested Algorithm for Management

Introduction

Intrauterine contraceptive devices (IUCD) are a commonly used, reversible, contraceptive method. Complications from insertion rarely include migration into the bladder. We report on two cases of intravesical migrated IUCD and present an algorithm for management based on recently published data.

Materials and Methods

The case records of two patients who underwent surgical procedures for migrated IUCD into the bladder were reviewed. A Pubmed search was performed to identify similar studies. A total of 25 papers met the criteria for inclusion.

Results

Both cases were managed with laparotomy and partial cystectomy. A review of literature suggests recently reported cases of IUCD migration are rising, with most cases having been reported in the last decade. Bladder calculus developing over the migrated IUCD is the most common presentation. Most cases have been managed using endourological techniques. A small number of cases have required open vesicolithotomy or laparoscopic surgery. Rarely, laparotomy has been required. 

Discussion

IUCD migration into the bladder remains rare, however, recently the number of reported cases has risen. A thorough physical examination and radiological evaluation are warranted. Management is surgical in all cases. Most cases can be managed with endourological techniques. A treatment algorithm has been suggested in this paper based on recent data.

Conclusion

With the rising use of contraception worldwide, the incidence of IUCD migration is possibly going to increase. Treating doctors need to be aware of the possible complications that may arise from a migrated IUCD, including bladder calculi.