Intravesical migration of intrauterine device

Abstract

Intrauterine devices have been plagued by many early and late complications, including uterine perforation and migration into adjacent structures. To our knowledge only 18 cases have been reported in the literature of migration of an intrauterine device into the bladder. We report on a 38-year-old woman in whom an intrauterine device eroded from the uterus 3 years after placement. The device remained asymptomatic in the pelvis for an additional 13 years before the patient presented with urinary symptoms. The literature is reviewed.

PIP: Physicians admitted a 38-year-old woman to the Stanford University Hospital in Palo Alto, California who had experienced pelvic pressure, suprapubic pain, urinary urgency, and terminal blood in the urine. Microscopic examination showed 15-25 leukocytes and 20-25 red blood cells per high power field in the urine. The culture grew no microorganisms. 16 years prior to admission, the patient had had a Dalkon shield IUD inserted. Yet 13 years prior to admission, she had a pelvic abscess and sepsis after the IUD perforated the uterus. Physicians then performed an emergency hysterectomy and removed both ovaries and Fallopian tubes. She experienced no more symptoms and physicians did not intervene further. Additional tests in the Stanford University hospital revealed a freely moving bladder stone with no mucosal erythema or edema. The physicians removed the 5.2 x 4.5 x 1.5 cm rough calcified mass. When they broke the stone, they found the intact Dalkon Shield IUD which had been completely surrounded by the calcified mass. The physicians were able to discharge the patient 5 days later. This hospital has had a total of 19 cases of uterine perforation by an IUD. The Lippes Loop caused most perforations (6 cases) which took place before 1977. After 1978, however, most cases involved the Dalkon shield (5 cases). Usually the patient had no symptoms when the IUD migrated, but erosion into the bladder often resulted in urinary symptoms, such as repeated urinary tract infections and/or blood in the urine. The duration of symptoms among the 19 cases, which developed many years after IUD insertion, before diagnosis varied from 3 months to 5 years. In the 8 cases where the IUD migrated to the bladder, the erosion took at least 10 years. The case reported here had the longest reported duration period. Once the IUD entered the bladder in 12 cases, calcium at least partially surrounded it.