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Urol Case Rep
Urol Case Rep
Urology Case Reports
2214-4420
Elsevier

S2214-4420(24)00124-4
10.1016/j.eucr.2024.102770
102770
Endourology
Intrauterine contraceptive device (IUCD) migration into the bladder with bladder stone formation: Case report
Nigusie Tsiyon tsiyonalemu2011@gmail.com
⁎
Solomon Fitsum fitsum.solomon@aau.edu.et

Degefe Mezgebe mezgebgdf@gmail.com

Almaw Samuel samuelyeab25@gmail.com

Tadele Abiy abiytadele701@gmail.com

Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
⁎ Corresponding author. PO BOX: 9086, ADDIS ABABA UNIVERSITY, School of Medicine, Department of Surgery, Urology Unit, Ethiopia. tsiyonalemu2011@gmail.com
19 6 2024
9 2024
19 6 2024
56 10277011 5 2024
12 6 2024
© 2024 Published by Elsevier Inc.
2024

https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Intrauterine contraceptive device (IUCD) is commonly used to prevent unwanted pregnancy. Migration of IUCD into the bladder is a rare complication. We present a case of a 38-year-old woman with a history of IUCD insertion 05 years ago, immediately following her last delivery. She had a history of unplanned pregnancy 05 months following the IUCD insertion. She also complained of lower urinary tract storage symptoms. Clinical examination revealed suprapubic tenderness. Non-contrast abdomino-pelvic CT scan and cystoscopy confirmed the presence of an IUCD in the bladder with an attached stone. Open Cystotomy was performed, successfully removing the bladder stone with the intravesical IUCD. The patient was discharged without complications and reported symptom resolution during follow-up. IUCD migration into the bladder is a rare but clinically significant complication. There should be a high index of suspicion of migration in a patient with unexpected pregnancy associated with urinary complaint following IUCD insertion.

Highlights

• IUD migration to the bladder can rarely occur causing storage urinary symptoms.

• Migrated IUD causes unexpected pregnancy and acts as a nidus for stone formation.

• CT scan and cystoscopy can confirm diagnosis of migrated IUD and the associated stone.

• Surgical removal of the migrated IUD with the stone is curative.

Keywords

Intrauterine contraceptive device
IUCD
Contraceptive
Bladder stone
Migration
Case report
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pmc1 Introduction

Intrauterine contraceptive device (IUCD) migration is a rare but noteworthy complication that can give rise to diverse clinical manifestations.1

This case report describes a 38-year-old woman presenting with lower urinary tract storage symptoms attributed to the migration of an IUCD into the bladder, resulting in the formation of a bladder stone. IUCD migration into the bladder is an uncommon occurrence, and its clinical implications can range from asymptomatic cases to presentations with significant lower urinary tract symptoms.2 The incident reported in this case aligns with the limited literature available on IUCD migration and underscores the importance of vigilance in managing contraceptive complications. Historically, IUCDs have been established as effective and reliable contraceptives, but their potential for migration and subsequent complications should not be overlooked.3

Literature review reveals sporadic instances of IUCD migration into adjacent structures, including the bladder, with varied clinical outcomes.4

The reported case draws attention to the need for a thorough understanding of the potential complications associated with IUCD use, particularly in patients who present with unexplained lower urinary tract symptoms and unplanned pregnancy.5

To date, there is a paucity of comprehensive studies documenting the incidence, clinical features, and optimal management strategies for IUCD migration into the bladder.6

This case report contributes to the existing body of knowledge by detailing a clinical scenario, emphasizing the significance of prompt diagnosis, and elucidating the successful management of this infrequent yet clinically relevant complication.

2 Case presentation

This was a 38-years-old Ethiopian woman who came to our hospital outpatient clinic with a complaint of 1-year history of lower urinary tract storage symptoms, characterized by urgency and frequency. The patient had a history of using IUCD 5 years ago which was inserted right after she gave birth to her 4th child. All her four children were delivered by SVD. She had no urologic or gynecologic complaint until 05 months later when she had unexpected pregnancy. The pregnancy was terminated at the patients’ request at local health facility. She was not evaluated further for the condition of the IUCD since she disappeared from follow-up until her current presentation.

The clinical examination revealed suprapubic tenderness. The gynecological examination was normal. Urine urinalysis and microscopy was done and it was negative for infection. Serum creatinine, hemoglobin, and white blood cells count were all in the normal limit.

Abdomino-pelvic non-contrast CT scan showed a 2cm by 2cm stone with an IUCD in the bladder (Fig. 1A–C). Cystoscopy showed the IUCD was located in the dome of the bladder, with one arm of the T-shaped IUCD found embedded in the bladder mucosa and a stone on the other arm (Fig. 2A and B).Fig. 1 Abdomino-pelvic non-contrast CT scan showing intravesical IUD with the attached stone.

Fig. 1

Fig. 2 Cystoscopy. (A and B) IUCD seen eroded through the bladder mucosa with attached stone.

Fig. 2

After discussing the options of management with the patient, open surgical management was decided. Under spinal anesthesia, through a pfannenstiel incision with extra-peritoneal approach, the bladder was identified. Cystotomy was performed and the IUCD was identified with one arm embedded in the bladder mucosa around the dome of the bladder. The bladder was mobilized away from the covering peritoneum and the fistula tract was witnessed to have sealed completely with a scar and there was no communication between the uterus and the bladder. The IUCD along with the bladder stone was removed (Fig. 3A and B). The bladder was closed in two layers with vicryl. A Foley urethral catheter was inserted.Fig. 3 Intraoperative images.

Fig. 3

The patient was discharged on the 3rd post-operative day without any complications. The catheter was removed on the 10th post-operative day at the outpatient clinic. 02 month after the procedure, patient was seen at the outpatient clinic and had no urinary complaint.

3 Discussion

IUCD migration, though uncommon, has been documented in various anatomical locations, including the bladder.2 The incidence of IUCD perforation is said to be 0.05/1000 to 13/1000.7 The etiology of such migrations remains multifactorial, which includes insertion of the device by inexperienced personnel, inappropriate position of the IUCD, susceptible uterine wall due to multiparity, and a recent abortion or pregnancy.3 Our patient is a multiparous who had the IUCD inserted right after her last delivery which can be a taken as a risk factor.

The clinical presentation of IUCD migration into the bladder can vary widely, ranging from asymptomatic, recurrent urinary tract infection, dyspareunia to lower urinary tract storage symptoms, as seen in our patient. The presence of suprapubic tenderness raised suspicion, leading to further imaging studies.

Imaging modalities, such as ultrasound, plain abdominal x-ray and abdomino-pelvic CT scans plays a crucial role in diagnosing IUCD migration into the bladder. In our case, the CT scan revealed a stone with the IUCD in the bladder, confirming the diagnosis. Cystoscopy further elucidated the extent of penetration, with one arm of the T-shaped IUCD embedded in the bladder mucosa and a stone on the other arm.

These findings are consistent with other reports emphasizing the value of imaging in confirming the diagnosis and guiding subsequent management strategies.7

The optimal management strategies may vary based on individual patient, institutional set up and clinical presentation. Typically, surgical intervention is mandatory.6 The intervention can be either open surgery or minimally invasive intervention including laparoscopic or endoscopic extraction using laser lithotripsy.8

In our set up, due to the limitations of minimally invasive options of management, open cystotomy and extraction of the IUCD along with the stone was done.

4 Conclusion

IUCD migration into the bladder is a rare complication which can have significant morbidity. IUCD should be inserted by a trained personnel following the standard procedural steps. Migration should always be suspected in a woman using IUCD as a contraceptive method and presenting with unplanned pregnancy and unexplained urinary complaint. The location and condition of the IUCD should be sought early.

Patients’ consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Ethical approval

Ethical approval was provided by the author's institution.

Source of funding

N/A.

Research registry

N/A.

CRediT authorship contribution statement

Tsiyon Nigusie: Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing. Fitsum Solomon: Supervision, Writing – review & editing. Mezgebe Degefe: Writing – review & editing. Samuel Almaw: Writing – original draft. Abiy Tadele: Resources, Writing – original draft.

Declaration of competing interest

No competing financial interests exist.
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References

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5 Tosun M. Intravesical migration of an intrauterine device detected in a pregnant woman J. Can. Urol. Assoc. 4 5 2010 141 143
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