Transurethral Removal of Perforated Intrauterine Device

Abstract

Video Objective To describe the management of a perforated IUD into the bladder, with removal of a fractured arm via a transurethral approach. Setting 36yo G1P1 with expired ParaGard IUD in place who experienced spontaneous detachment of the IUD strings with attempted removal in the office. Pelvic ultrasound showed evidence of one IUD arm perforating the bladder, which was also confirmed on office cystoscopy. She was scheduled to undergo attempted hysteroscopic IUD removal, but also consented for laparoscopy as she desired a permanent sterilization procedure. Interventions Cystoscopy was first performed, confirming one arm of the IUD perforating the bladder dome. Laparoscopy was performed, noting the incidental finding of the second IUD arm perforating the uterine fundus. Adhesions between the fundus, bladder dome, and omentum were noted. Hysteroscopy was performed in attempt to remove the IUD while under laparoscopic guidance. With traction on the IUD body, the IUD was partially removed, but one of the arms was noted to have fractured off. Laparoscopically, it was evident the arm perforating the fundus remained in situ. While attempting to remove the fractured arm via laparoscopy, the arm spontaneously retracted into the myometrium. Bilateral salpingectomy was performed for permanent sterilization. The bladder adhesion was divided and the cystotomy from the perforated arm was repaired. Repeat hysteroscopy was performed but the fractured arm was not visualized. Repeat cystoscopy revealed the fractured arm free within the bladder. The arm was removed transurethrally with a cystoscopic grasper. Conclusion When planning surgery to remove a perforated IUD, a surgeon must consider and be prepared to perform multiple approaches for removal in the event of IUD fracture.