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BLADDER CALCULUS RESULTING FROM THE MIGRATION OF AN INTRAUTERINE CONTRACEPTIVE DEVICE
0022-5347/04/1725-1903/0 THE JOURNAL OF UROLOGY® Copyright © 2004 by AMERICAN UROLOGICAL ASSOCIATION
Vol. 172, 1903, November 2004 Printed in U.S.A.
DOI: 10.1097/01.ju.0000142135.94531.bb
BLADDER CALCULUS RESULTING FROM THE MIGRATION OF AN INTRAUTERINE CONTRACEPTIVE DEVICE ´ NDEZ,* RAUL YORDA ´ N, ALLEN F. MOREY, RICARDO AVILE ´S ERIC J. HICK, JAVIER HERNA ´A AND CARLOS R. GARCI From the Urology Service, Department of Surgery (EJH, JH, AFM) and Urogynecology Division, Department of Obstetrics/Gynecology (RY), Brooke Army Medical Center, Fort Sam Houston, Texas, and Departamento de Urologı´a, Hospital Escuela, Tegucigalpa, Honduras (RA, CRG) KEY WORDS: bladder calculi, intrauterine devices, foreign body migration
Intrauterine contraceptive device migration into the bladder with resultant calculus formation is a rare event, with fewer than 20 cases reported in the literature.1 Patients initially present with irritative voiding symptoms, hematuria and recurrent urinary tract infections. We report a rare case of intravesical migration of an intrauterine contraceptive device (IUD) with secondary bladder calculous formation in a woman with 2 pregnancies after IUD insertion. CASE REPORT
A 31-year-old female presented with progressively worse irritative voiding symptoms and recurrent urinary tract infections 8 months in duration treated empirically with antibiotics elsewhere. The patient also had moderate stress urinary incontinence symptoms. Several years before these symptoms she had an IUD placed without complication. Interestingly, she reported being pregnant on 2 occasions between the time of IUD insertion and current presentation. Physical examination was remarkable for a palpable intravesical mass via the anterior vaginal wall and moderate bladder neck descensus with urinary leakage noted with Valsalva maneuver. Plain radiograph of the pelvis revealed the IUD within a large bladder calculus (fig. 1). The patient subsequently underwent cystolithotomy with Burch colposuspension. Recovery and postoperative course were uneventful. The bladder calculus measured 4 ⫻ 8 cm grossly and the IUD was noted within the lamellated calculus radiographically (fig. 2).
FIG. 1. Pelvic radiograph demonstrates IUD within large bladder calculus.
DISCUSSION
Intrauterine contraceptive device intravesical migration has been reported in fewer than 50 cases in the literature. However, fewer than half of these cases have resulted in bladder calculus formation.1 Interestingly, our patient also had 2 uneventful pregnancies after placement of the IUD. Moreover, similar cases have been reported in the literature.2, 3 Maskey et al reported on a 26-year-old woman who had 3 children after an IUD was placed 7 years previously.3 The patient was lost to followup during that time but returned with lower urinary tract symptoms and radiographic evidence of a T-shaped bladder calculus, which was removed via cystolithotomy. The majority of patients with large bladder calculi secondary to migrated IUDs present with irritative lower urinary tract symptoms, hematuria, suprapubic discomfort and re-
FIG. 2. A, bladder calculus. B, plain radiograph of IUD within lamellated bladder calculus.
current urinary tract infections. Intravesical migration of an IUD with or without secondary calculus formation should be considered in the differential diagnosis in any woman previously fitted with an IUD who experiences these clinical symptoms.
Accepted for publication June 11, 2004. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the US Government. * Correspondence: Division of Urology—UTHSCSA, 7703 Floyd Curl Dr., San Antonio, Texas 78229-3900 (telephone: 210-567-5676; FAX: 210-567-6868; e-mail: [email protected] or javier.hernandez@ us.army.mil).
1903
REFERENCES
1. Ozcelik, B., Serin, I. S., Basbug, M., Aygen, E. and Ekmekcioglu, O.: Differential diagnosis of intra-uterine device migrating to bladder using radiographic image of calculus formation and review of literature. Eur J Obstet Gynecol Reprod Biol, 108: 94, 2003 2. Rafı´que, M.: Vesical calculous: a complication of intravesical migration of intrauterine contraceptive device. Int Urogynecol J Pelvic Floor Dysfunct, 13: 380, 2002 3. Maskey, C. P., Rahman, M., Sigdar, T. K. and Johnsen, R.: Vesical calculus around an intra-uterine contraceptive device. Br J Urol, 79: 654, 1997
Vol. 172, 1903, November 2004 Printed in U.S.A.
DOI: 10.1097/01.ju.0000142135.94531.bb
BLADDER CALCULUS RESULTING FROM THE MIGRATION OF AN INTRAUTERINE CONTRACEPTIVE DEVICE ´ NDEZ,* RAUL YORDA ´ N, ALLEN F. MOREY, RICARDO AVILE ´S ERIC J. HICK, JAVIER HERNA ´A AND CARLOS R. GARCI From the Urology Service, Department of Surgery (EJH, JH, AFM) and Urogynecology Division, Department of Obstetrics/Gynecology (RY), Brooke Army Medical Center, Fort Sam Houston, Texas, and Departamento de Urologı´a, Hospital Escuela, Tegucigalpa, Honduras (RA, CRG) KEY WORDS: bladder calculi, intrauterine devices, foreign body migration
Intrauterine contraceptive device migration into the bladder with resultant calculus formation is a rare event, with fewer than 20 cases reported in the literature.1 Patients initially present with irritative voiding symptoms, hematuria and recurrent urinary tract infections. We report a rare case of intravesical migration of an intrauterine contraceptive device (IUD) with secondary bladder calculous formation in a woman with 2 pregnancies after IUD insertion. CASE REPORT
A 31-year-old female presented with progressively worse irritative voiding symptoms and recurrent urinary tract infections 8 months in duration treated empirically with antibiotics elsewhere. The patient also had moderate stress urinary incontinence symptoms. Several years before these symptoms she had an IUD placed without complication. Interestingly, she reported being pregnant on 2 occasions between the time of IUD insertion and current presentation. Physical examination was remarkable for a palpable intravesical mass via the anterior vaginal wall and moderate bladder neck descensus with urinary leakage noted with Valsalva maneuver. Plain radiograph of the pelvis revealed the IUD within a large bladder calculus (fig. 1). The patient subsequently underwent cystolithotomy with Burch colposuspension. Recovery and postoperative course were uneventful. The bladder calculus measured 4 ⫻ 8 cm grossly and the IUD was noted within the lamellated calculus radiographically (fig. 2).
FIG. 1. Pelvic radiograph demonstrates IUD within large bladder calculus.
DISCUSSION
Intrauterine contraceptive device intravesical migration has been reported in fewer than 50 cases in the literature. However, fewer than half of these cases have resulted in bladder calculus formation.1 Interestingly, our patient also had 2 uneventful pregnancies after placement of the IUD. Moreover, similar cases have been reported in the literature.2, 3 Maskey et al reported on a 26-year-old woman who had 3 children after an IUD was placed 7 years previously.3 The patient was lost to followup during that time but returned with lower urinary tract symptoms and radiographic evidence of a T-shaped bladder calculus, which was removed via cystolithotomy. The majority of patients with large bladder calculi secondary to migrated IUDs present with irritative lower urinary tract symptoms, hematuria, suprapubic discomfort and re-
FIG. 2. A, bladder calculus. B, plain radiograph of IUD within lamellated bladder calculus.
current urinary tract infections. Intravesical migration of an IUD with or without secondary calculus formation should be considered in the differential diagnosis in any woman previously fitted with an IUD who experiences these clinical symptoms.
Accepted for publication June 11, 2004. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the US Government. * Correspondence: Division of Urology—UTHSCSA, 7703 Floyd Curl Dr., San Antonio, Texas 78229-3900 (telephone: 210-567-5676; FAX: 210-567-6868; e-mail: [email protected] or javier.hernandez@ us.army.mil).
1903
REFERENCES
1. Ozcelik, B., Serin, I. S., Basbug, M., Aygen, E. and Ekmekcioglu, O.: Differential diagnosis of intra-uterine device migrating to bladder using radiographic image of calculus formation and review of literature. Eur J Obstet Gynecol Reprod Biol, 108: 94, 2003 2. Rafı´que, M.: Vesical calculous: a complication of intravesical migration of intrauterine contraceptive device. Int Urogynecol J Pelvic Floor Dysfunct, 13: 380, 2002 3. Maskey, C. P., Rahman, M., Sigdar, T. K. and Johnsen, R.: Vesical calculus around an intra-uterine contraceptive device. Br J Urol, 79: 654, 1997