Vesical Calculus: A complication of Intravesical migration of Intrauterine device (IUD)

Abstract

Introduction: Migration of intrauterine contraceptive device (IUD) into urinary bladder is not very common. Secondary stone formation is a rare complication. It occurs as a result of complete migration of the IUD into urinary bladder. To date, more than 80 cases of IUD migration to the bladder have been reported in the literature with varying stone sizes. A series of 15 cases to whom an IUD migrated from the uterus to the bladder and resulted in formation of a stone over it. Methods: A cohort of fifteen women was treated for bladder stones over migrated IUD within June 2004 to May 2012. Detailed history was maintained, diagnosis was established by pelvic ultrasonography and/or X-rays pelvis. All cases were managed by endoscopy. All cases undergo Cystoscopy and litholapexy. Results: The mean age of participants was 39.7+5.29 years (28-49). Major objection in almost all cases was lower urinary tract symptoms; which were not responding to medical treatment, six patients had fewepisodes of macroscopic hematuria. The interval between insertion of IUD and onset of symptoms ranged from 2 to 5 years. In twelve cases IUD was embedded in urinary bladder wall and an entire intravesical IUD in rest 3 with calculus formation in all of them. Stones were crushed along with retrieval of IUD as a result of which mild hematuria was reported in 4 cases. Patients remained with Foley catheter from 7 - 14 days. Postoperative recovery was uneventful. Conclusion:  Intrauterine contraceptive device (IUD) perforation to the bladder, with stone formation, is an uncommon event. Clinically it is difficult to reach its diagnosis but persistence of lower urinary tract symptoms in women with IUD should raise the suspicion of intravesical migration. Sonologist can define intravesical migrated IUD. Endoscopy proved a better and safe procedure with a very low complication rate.