A Case of Intrauterine Device Migration to the Urinary Bladd
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A 51-year-old woman presented to the urology outpatient department at a regional hospital with a 6-month history of intermittent pink urine. A cystoscopy showed a rod-shaped mass in the bladder. A post-procedure abdominal computed tomography confirmed an intrauterine device (IUD) with penetration of the bladder. Further history confirmed she had a ParaGard® IUD about ten years prior to presentation. We planned a laparoscopy for retrieval of the IUD and communicated with the urologist regarding the need for a possible concurrent urological procedure.

Laparoscopy revealed the extrauterine location of the IUD. The 2 short arms of the IUD were covered by the omentum, and the long tail penetrated the bladder. We divided the adhesion between the IUD, omentum, and bladder. However, the IUD broke during adhesiolysis and needed to be removed in 2 pieces— the short arms with attached omental tissue and a long tail. The bladder was repaired using 2-layer continuous sutures with 3-0 V-LocTM. She was discharged with a transurethral Foley catheter that was removed 2 weeks later. At the one-month follow-up, she was asymptomatic.

IUD's are safe, convenient methods of female contraception. Complications may include expulsion, pelvic inflammatory disease, ectopic pregnancy, and unplanned pregnancy. IUD perforation is rare, with an incidence of 0.87 per 1000 insertions with few reported surgical series for extrauterine IUD retrieval. Laparoscopic removal is recommended as first-line treatment in symptomatic patients and as a reasonable treatment option in asymptomatic patients. In our patient, IUD migration to the urinary bladder caused her symptoms and to reduce urinary complications, we identified the bladder mucosa and fibrous connective tissue and repaired the bladder layer-by-layer by using 3-0 V-LocTM. A similar surgical approach could be used in similar cases.

Read more : https://www.jmig.org/article/S1553-4650(21)00076-5/fulltext?rss=yes
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