Extensive intravesical benign hyperplasia induced by an extr
A 38-year-old woman presented to a local hospital with a history of recurrent urinary urgency and dysuria and without macroscopic hematuria for 1 month. Urinalysis revealed leukocyturia (133/HP) and hematuria (25/HP). The patient was sexually active and was initially diagnosed with uncomplicated urinary infection. The patient received norfloxacin for 1 week. However, the symptoms remained unrelieved, and she was consulted for further examinations in the local hospital. As urinary ultrasound indicated thickening of the bladder anterior wall, further an abdominal contrast-enhanced computed tomography (CT) was carried out, through which more lesions were found, and malignant changes were highly suspicious. The cystoscopy from the primary hospital identified extensive basal mass in the bladder walls and the histological results of tissue biopsy revealed non-invasive urothelial carcinoma. Radical cystectomy was recommended by the provincial hospital owing to the extensive involvement of the bladder.

The patient considered the possibility of radical cystectomy to be devastating and presented at our hospital for consultation. A review of the patient's medical history revealed that the patient had undergone a Chinese IUD (Copper-bearing) placement 11 years ago after the birth of her first child. However, she became pregnant and underwent a painless induced abortion 3 months later, and the routine gynecological sonography revealed no IUD. After the following 2 accidental pregnancies, she underwent another IUD placement which worked well. Considering the above-mentioned history, our CT scanning revealed that a portion of one of the two implanted IUDs had migrated beyond the right uterus wall and was adjacent to the bladder. To verify the pathological diagnosis, diagnostic transurethral resection was performed (Fig. 1c, d), including the right, top, and trigone bladder wall, whereas histological examinations reported granuloma of the bladder right and top wall and glandular cystitis of the triangle wall. The result of the pathological analysis at the local hospital was sent to our pathology department for final confirmation, while result also revealed a benign granuloma.

As the results were controversial, a therapeutic (deeper and wider) transurethral bladder resection was performed in our hospital, and the pathology examination revealed the same benign conclusion. Finally, the uterus-IUD was removed at a gynecological clinic and the migrated IUD was removed by the cooperation of an urologist, gynecologist, and gastroenterologist. After the therapeutic transurethral bladder resection, the patient's lower urinary tract symptoms gradually disappeared. No recurrent lesion was noted in the bladder through computed tomography (CT) 3 months later (see Timeline, Supplemental Content, which illustrates the whole treatment process).

Source: Medicine: May 2019 - Volume 98 - Issue 20 - p e15671

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