The rolling stone: migration of an intrauterine device leading to bladder stone formation nine years after insertion: a case report

Abstract

Background: Intrauterine devices are safe, affordable, convenient, and the most common form of contraception used by females of childbearing age in Palestine. A rare complication of intrauterine devices is migration to nearby structures, rarely the urinary bladder, leading to bladder stone formation.

Case presentation: A 34-year-old female patient presented due to repeated urinary tract infections and flank pain associated with lower urinary tract symptoms, including dysuria, frequency, and gross hematuria. Subsequent laboratory tests revealed a past medical history of iron-deficiency anemia. Urinalysis revealed hematuria and pyuria, and the urine culture confirmed colonization of Escherichia coli. Computed tomography revealed an irregularly shaped 5.5 cm hyperdense calculus in the urinary bladder. Open cystolithotomy was done to extract the calculus, which was later incidentally revealed to be encrusting a migrated intrauterine device.

Conclusions: This case highlights the rare potential for intrauterine devices to migrate to the urinary bladder, leading to calculus formation, which, in this case, was discovered in this patient nine years post-insertion. The intrauterine device perforation into the urinary bladder was due to delayed inflammatory migration. This case underscores the critical need for both patient and physician education in low-resource settings on the warning signs of intrauterine device migration, including new-onset irritative lower urinary tract symptoms, hematuria, and missing intrauterine device threads, ensuring routine scheduled follow-ups, patient self-checks, and timely imaging can aid in early detection and prevent complications associated with intrauterine device migration.

Keywords: Copper IUD; IUD migration; Lower urinary tract symptoms; Open cystolithotomy; Recurrent urinary tract infections; Urinary bladder stone.

Fig. 1

Initial Kidney-Ureter-Bladder (KUB) X-ray. Plain KUB X-ray showing a an irregular hyperdense structure in the pelvis, surrounded by a dense radio-opaque shadow consistent with a bladder calculus

Fig. 2

CT scan showing an large hyperdense intravesical calculus. Axial CT image (soft tissue window) shows a large hyperdense calcified calculus in the urinary bladder with surrounding bladder wall thickening (red arrows)

Fig. 3

CT imaging (bone window) showing an intravesical stone formation around an IUD. (a) Axial CT image (bone window) showing a large, intravesical mass with concentric calcifications with a central linear hyperdense structure consistent with an IUD. (b) Sagittal CT image (bone window) reveals the typical T-shape of the copper IUD encrusted in a calcified calculus

Fig. 4

Gross appearance of the extracted intravesical calculus. (a) Gross specimen of the retrieved bladder stone exhibiting the typical (T) shape of the copper IUD. (b) Bisection of the stone reveals the embedded copper IUD which acted as the nidus from calculus formation with apparent concentric calcification