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.
Highlights
Intrauterine contraceptive devices (IUCDs) are widely employed to achieve reversible contraception
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
Uterine perforation can occur during copper IUCDs (Cu-IUCD) insertion in about 1.6 per 1,000 insertions [1]
Summary
Intrauterine contraceptive devices (IUCDs) are widely employed to achieve reversible contraception. We report a case of a 50-year-old woman who presented with asymptomatic stone formation over a Cu-IUCD, which migrated into the bladder. The patient was asymptomatic for 25 years, which explains the delay in the diagnosis and treatment This case represents the longest period of forgotten and migrated Cu-IUCD with calculus formation reported in the literature. A 50-year-old woman presented to our outpatient department with a frequency of micturition and dysuria of one-week duration She denied any other urogynecological symptom or previous urological surgery. An ultrasonography of the abdomen and pelvis revealed normal upper tracts with two calculi of 3 cm and 4 cm each in the bladder. Roentgenogram of the KUB (kidney, ureter, and bladder) region revealed two large radio-opaque calculi in the bladder, with clear evidence of one of the stones being formed around a linear radio-opaque intravesical foreign body (Figure 1). The calculi were removed followed by closure of the cystotomy, and the patient made an uneventful recovery (Figure 5)
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