An Unusual Cause of Vesical Calculi

Abstract

Intravesical migration is an uncommon but serious complication of intrauterine contraceptive devices. Calculus formation is common over such migrated intrauterine contraceptive devices. This dreaded complication usually presents with lower urinary tract symptoms such as suprapubic pain, frequency, and nocturia. We present a case of a 50-year-old woman with intravesical migration of copper-T device placed in the immediate postpartum period 25 years ago. She presented with dysuria, which was confirmed by computed tomography. The migrated device was encrusted with a 3.5-cm-sized stone around its vertical limb. Another stone of approximately the same size was present in the bladder. Surprisingly, the patient never had symptoms and hence she never followed up for 25 years. The stones could not be removed endoscopically, and therefore an open vesicolithotomy was performed. This case has been presented to highlight the significance of following up patients with intrauterine contraceptive devices to avoid potentially devastating complications.

Keywords: copper intrauterine contraceptive devices; encrustation; migration; vesical calculus.

Figure 1. X-ray image of the kidney, ureter, and bladder region showing the presence of two vesical calculi with a linear radio-opaque extension suspicious of foreign body (yellow arrow)

Figure 2. Transverse section of noncontrast computed tomography showing one of the limbs of the copper intrauterine contraceptive device (yellow arrow) embedded within the right lateral bladder wall with overlying calculus

Figure 3. Sagittal section of noncontrast computed tomography depicting two bladder stones, with one hanging from the bladder wall partly embedded within bladder mucosa (yellow arrow)

Figure 4. Cystoscopic view of the migrated intrauterine contraceptive device showing the horizontal limb buried within the bladder mucosa (yellow arrow) and stone formation around the vertical limb

Figure 5. Postoperative image of the vesical calculi formed around the vertical limb of the intrauterine contraceptive device, with the arrow pointing to the horizontal limb