Intrauterine devices migrated into the bladder: two case reports and literature review

Abstract

Background: Intrauterine devices (IUD) are widely used all over the world. One of the most serious complications is uterine perforation, and it is very rare for the IUD to penetrate the bladder after perforation. Here we report two cases of IUD migration into the bladder, and review the literature to analyze the possible causes and solutions of such complications.

Case presentation: Case NO. 1 is a 37-year-old female who presented lower urinary tract symptoms for a year. Cystoscopy showed that a strip of metal penetrated into the bladder, and the surface was covered with stones. The patient underwent cystotomy and foreign body removal under general anesthesia. Case NO. 2 is a 46-year-old woman who previously inserted an IUD in 1998, but she had an unexpected pregnancy in 1999. Her doctor believed that "the IUD had spontaneously expulsed" and a new IUD was inserted after her pregnancy was terminated. Her CT scan showed an IUD on the left side of the bladder and another IUD in the uterus. Her foreign body was removed by cystotomy.

Conclusion: Patients with IUD should be suggested to check the device regularly, and those who with a missed IUD have to rule out the possibility of IUD migration. For patients with IUD combined with lower urinary tract symptoms, it is necessary to be aware of whether IUD perforation affects the bladder.

Keywords: Bladder; Case report; Intrauterine devices; Lower urinary symptoms; Migration.

Fig. 1

IUD of case NO.1 (a: CT scan indicating a triangular foreign body penetrated the bladder wall. b: Cystoscopy showed a strip of metal substance penetrated through the bladder wall, and the surface was covered with stones. c: Intraoperative photograph showed that a branch of the IUD passed through the bladder wall. d: The removed IUD.)

Fig. 2

IUDs of case NO.2 (a and b: IVP demonstrating two IUDs in the pelvic cavity, one of them was in the bladder. c: Her CT scan showing an IUD penetrated the left side of the bladder. d: The removed IUD.)