Intravesical migration of a Chinese intrauterine device and secondary stone formation: diagnostic investigation and laparoscopic management.

Abstract

Intravesical migration and secondary stone formation are rare complications of intrauterine devices (IUD) and 47 cases have been reported in the English-language literature since 1974. However, only one such case was managed purely by laparoscopy [1]. The authors present another case in which a Chinese IUD (AiMu MCu) partially migrated to the bladder and was complicated by bladder stone formation, which was successfully managed by laparoscopy under the joint efforts of urologists and gynecologists. A 35-year-old woman (gravida 1, para 1), in whom an AiMu MCu IUD had been inserted 10 years earlier, had been experiencing intermittent episodes of irritative voiding symptoms and gross hematuria for 3 years. She had been treated empirically for urinary tract infection with oral antibiotic therapy several times without further investigation. Urinalysis showed leukocyturia and hematuria. Physical examination was normal. Abdominal plain X-ray showed a displaced Vshaped IUD with a surrounding hyperdense mass in the pelvis (Fig. 1a). Pelvic CT showed that the IUD was partly intrauterine and partly intravesical with stone formation (Fig. 1b). Cystoscopy revealed an IUD penetrating the posterior bladder wall with calculus formation (Fig. 1c). The IUD and stone were successfully removed by laparoscopy (Figs. 2, 3a). A urethral catheter was retained for 2 weeks and the recovery was uneventful. The AiMu MCu (Fig. 3b) is a new Chinese IUD and very popular in China. However, it accounts for nearly one-third (30.5 %; 72 out of 236) of ectopic IUDs [2]. The present case reminds the readers that this type of IUD, which is rarely used outside China, can cause uterine perforation. Persistent lower urinary tract symptoms in women with IUD should raise the suspicion of intravesical migration [3]. We also stress the importance of the cooperation of urologists and gynecologists to work together for such patients. Laparoscopy is a minimally invasive alternative to open surgery in the management of this condition [1].