[P-040]
Intrauterine Contraceptive Device Which Migrated to the Bladder and Calculus Formation: A Case Report
Mehmet Gökhan Çulha, Bülent Mansuroğlu, Nejdet Karşıyakalı, Uğur Yücetaş, Ali Ferruh AkayINTRODUCTION: Intrauterin contraceptive devices (IUD) are frequently used as a method of birth control. The side effects such as vaginal bleeding and localized pelvic pain are most common, and uterine perforation and migration of the adjacent organs are rare but serious complications. In this case, we present a 46 year-old woman who had a bladder stone because of a IUD that had migrated to bladder encrusted.
CASE: A 46 year-old woman admitted to urology clinic with complaints of pollakuria and dysuria, ongoing for three years. She emphasize that her complaints has begun after implantation of IUD. This patient used cefuroxime axetil 500 mg and ciprofloxacin 500 mg for recurrent uriner system infection. Physical examination was normal except suprapubic tenderness. Laboratory findings were normal except leucocyturia. We determined a calcified IUD in pelvic area at plain abdominal radiography. (Figure-1). The IUD, which is calcified and migrated has been confirmed in bladder at non-contrast computer tomography. (Figure-2A and B). After all of that, we performed cystoscopy under spinal anesthesia. The stone, which was on the surface of the IUD was fragmented by laser lithotripsy (Sphinx, Lisa Laser, USA). (Figure-3). After fragmantetion, IUD has removed of the bladder by forceps. We did not see any abnormal formation or fistula in the bladder during control cystoscopy. We performed a foley catheter at end of the operation. At control plain abdominal radiograhy, we did not observe bladder stone and the patient discharged with double antibiotics (cefpodoxime 200 mg 2*1 and metronidazole 500 mg 2*1) post-operative first day. There is no complaint at post-operative first month during outpatient clinic control.
Conclusıon: Migration of IUD is a rare complication. In these cases, IUD can extirpate by laparotomic, laparoscopic or endoscpic approach. Cystoscopy and laser lithotripsy is an effective, reliable and minimal invasive treatment of migrated IUD.
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Figure-1: Stoned intrauterin contraceptive device in the pelvic area. Plain abdominal radyography image
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Figure-2: Migrated to bladder and stoned intrauterin contraceptive device image at computer tomography (A: Axial section)
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Figure-2: Migrated to bladder and stoned intrauterin contraceptive device image at computer tomography (B: Coronal section)
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Figure-3A: The fragmantation of stoned IUD by endoscopic laser lithotripsy
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Figure-3B: Removing of migrated IUD by forceps