Author(s): Sallami Sataa, Ben Rhouma Sami, Rebai Sabeur, Cherif Karim, Horchani Ali
Background and Aims: Although perforation of the uterus by an intrauterine contraceptive device is not uncommon, intravesical migration and secondary stone formation is a very rare complication. We report a series of 10 women in whom an intrauterine contraceptive Copper-T device migrated from the uterus to the bladder and resulted in formation of a stone.
Methods: Between May 1995 and January 2009, ten women were treated for bladder stones because of migrated intrauterine contraceptive device. Diagnosis was established after performing pelvic ultrasonography and/or intravenous urogram. We describe history, clinical course, diagnostic workup and treatment data obtained from the hospital charts.
Results: The mean age was 42.6 ys (33-59). Persistent lower urinary tract symptoms were the main complaint in almost all cases, while four patients presented with macroscopic hematuria. The interval between insertion of intrauterine contraceptive device and onset of symptoms ranged from 2 to 12 ys. Cystoscopy revealed partial intravesical position of the intrauterine contraceptive device in 9 cases and an entire intravesical intrauterine contraceptive device in one case with calculus formation in all cases. All patients underwent endoscopic lithotripsy of the stone with extraction of intrauterine contraceptive device. Procedures went well with no complications. Patients received urinary drainage for 10 days. Postoperative course was uneventful with a 2 years follow-up.
Conclusion: intrauterine contraceptive device perforation to the bladder, with stone formation, is a rare event. Persistent lower urinary tract symptoms in women with intrauterine contraceptive device should raise the suspicion of intravesical migration. Ultrasonography permitted excellent depiction of intravesical migrated intrauterine contraceptive device. Endoscopic retrieval is feasible and safe procedure.