Retrieval of a missing translocated IUD using combined laparoscopic and cystoscopic techniques

A 41-year-old woman – gravida 6 para 6, was admitted with recurrent LUTS for seven months, including – frequent urination, urgency, and gross hematuria. 

The lady had a history of copper intrauterine contraceptive device (IUCD) use––placed several years before an unexpected pregnancy. After her last delivery ten years ago, a new IUCD was inserted as no residual device was seen on ultrasonography. She experienced no issues until seven months prior when she developed persistent urinary symptoms. 

Her physical examination at presentation was unremarkable. The urine culture suggested infection. A kidney, ureter, and bladder (KUB) X-ray revealed an IUCD and linear radiopaque material above and medial to it; ultrasound identified a hyperechoic shadowing material at the bladder dome. 

The gynecologist removed the IUCD, and a CT scan showed a T-shaped foreign body embedded in the upper part of the posterior bladder wall, causing local inflammation. The diagnosis was intravesical IUCD migration.Cystoscopy revealed the IUCD stem penetrating the posterior bladder wall with multiple small calculi attached. 

Cystoscopic removal was unsuccessful, prompting a laparoscopic surgery under general anesthesia. The surgery revealed multiple adhesions from the anterior abdominal wall to the bladder dome. Adhesiolysis was performed, and the IUCD was found protruding from the posterior bladder wall. The bladder was inflated with saline, and the anterior wall was dissected. A cystoscope was used for further exploration, and the IUCD was removed. The bladder defect was closed with a peritoneal flap, and a methylene test confirmed no leakage. The patient was discharged three days later without complications.

On a follow-up two weeks post-surgery, retrograde cystography showed no leakage or fistula formation, and the Foley catheter was removed. 

This case highlights the importance of considering IUCD migration in patients with a history of IUCD and pregnancy. Regular checks are crucial for IUCD users, and an abdominal pelvic X-ray should be performed if the device is not detected. Those experiencing urinary symptoms should be aware of potential bladder involvement due to IUCD perforation. Urologists and obstetricians must be vigilant and knowledgeable about this rare but significant issue.

Source: Natsheh ST, Manasra MR, Hammouri AG, et al. Case Reports in Obstetrics and Gynecology. 2024;2024.