Case report: Bladder stone caused by dislocated Cu-IUD.

INTRODUCTION AND IMPORTANCE

The intrauterine device, usually in the form of a copper IUD or levonorgestrel intrauterine system, is a widely used contraceptive method. The risk of uterine perforation is low and ranges from 0.3 to 2.2 per 1000 insertions for Cu-IUD. The bladder, with 24 %, is, after the bowel, the second most common location among all intra-abdominal locations of the migrated IUDs, which can cause development of a bladder stone.

CASE PRESENTATION

We present a case of a 32-year-old woman who attends with increasing dysuria. She reported using an IUD before her last pregnancy. Abdominal sonography and computed tomography revealed a lost IUD migrated into the bladder with stone formation. An open abdominal cystotomy was carried out in order to remove the IUD. Patient reported improvement of the symptoms postoperatively.

CLINICAL DISCUSSION

In the case of transvesical migration of IUD, lower urinary tract symptoms can occur and vesicolithiasis can develop. If the IUD is completely inside the bladder or if it gets small stones inside it, the device and stones may need to be removed through a cystoscopic or suprapubic approach. When large stones have formed or when the IUD has partially penetrated the bladder wall, open surgery has been the method of choice for removal.

CONCLUSION

In case of migrated IUD, a vaginal and abdominal ultrasound, X-rays, and computed tomography are useful tools for detecting dislocated IUDs. For the treatment physicians can choose a cystoscopic, laparoscopic, or abdominal approach based on the symptoms, the size of the stones, the IUD's location on the bladder wall, and their experience in laparoscopy and open surgery. If patients report dysuria after inserting of IUD a migrated IUD into the bladder should be taken into account.