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CASE REPORT
Year : 2001  |  Volume : 18  |  Issue : 1  |  Page : 78-79
 

Urinary bladder perforation by an intrauterine contraceptive device


Departments of Urology and Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthi Gram, India

Correspondence Address:
A R Jayadeva
219, 10th C Main Road, Jaya Nagar, First Block, Bangalore
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Urinary Bladder; Perforation: IUCD


How to cite this article:
Jayadeva A R, Lakshmi A Y. Urinary bladder perforation by an intrauterine contraceptive device. Indian J Urol 2001;18:78-9

How to cite this URL:
Jayadeva A R, Lakshmi A Y. Urinary bladder perforation by an intrauterine contraceptive device. Indian J Urol [serial online] 2001 [cited 2020 Jul 15];18:78-9. Available from: http://www.indianjurol.com/text.asp?2001/18/1/78/37460



   Introduction Top


Urinary bladder perforation by an Intrauterine Contraceptive Device (IUCD) is a rare entity. Here we report a case of perforation of urinary bladder by IUCD and its management.


   Case Report Top


A 34-year-old female, mother of 3 children, presented with history of dysuria of one-year duration. There was history of IUCD placement after a second delivery and she was told later that the IUCD was missing, and subsequently she became pregnant, which resulted in normal delivery. When she was evaluated for the dysuria elsewhere she was found to have left vesico ureteric junction calculus and referred here for management. Evaluation here revealed microhematuria, X-Ray KUB showed presence of copper-T with encrustation in the pelvic area [Figure]. Ultrasound study revealed normal upper urinary tracts, evidence of copper-T in the urinary bladder jutting from the uterus. Cystoscopy showed the stem of copper-T with encrustation around, ejecting from left lateral wall of bladder above the ureteric orifice. In the same sitting the copper-T was removed through the cystoscope and patient had uneventful post-procedure period and was relieved of symptoms.

Intrauterine contraceptive device (IUCD) generally is a safe and effective method of contraception. Apart from vaginal bleeding, pain and expulsion, rarely IUCD may result in uterine perforation and injury to the adjacent viscera such as appendix, rectum, sigmoid colon and urinary bladder.[1],[2],[3],[4],[5],[6] The reported rates of uterine perforation by IUCD ranged from 0.2 per 1000 to 9.6 per 1000 insertions.[4],[5] The uterine perforation by IUCD was first described in 1930 by Murphy and Andrews independently.[4] Caspi et al mentioned that only about 19 cases were reported in the literature till 1996.[3] The uterine perforation was reported with various types of IUCDs including Lippe's loop, Dalkon shield type and copper-T type devices.[2],[7] The presenting features of bladder perforation by IUCD are irritative voiding symptoms, menouria (hematuria during menses). repetitive and recalcitrant urinary infections and secondary bladder calculus disease.[1],[2],[3] In most of the situations history of having used or is currently using an IUCD, hematuria. pyuria and or urinary infection, plain X-rays of pelvis. pelvic sonography and cystoscopy help in the diagnosis. Free floating IUCD is usually removed by cystoscopy and if adherent it may need cystotomy for removal.[1],[2],[3],[4],[5] Thus it is prudent to remember this complication of bladder perforation by IUCD in any woman who presents with voiding symptoms, repeated attacks of urinary infection and secondary vesical calculus.

 
   References Top

1.Killholma P. Mankinen J. Vuori J. Bladder perforation: uncommon complication with a misplaced IUD. Advances in Contraception 1989: 5: 47-49.  Back to cited text no. 1    
2.David Zakin. Perforation of bladder by the intrauterine device. Obstet Gynecol Survey 1984: 39: 59-66.  Back to cited text no. 2    
3.Caspi B. Rabinerson D. Appleman Z. Kaplan B. Penetration of the bladder by a perforating intrauterine contraceptive device: a sonographic diagnosis. Ultrasound Obstet Gynecol 1996: 7: 458-460.  Back to cited text no. 3    
4.Thromalla JV. Perforation of Urinary bladder by intrauterine device. Urology 1986: 27: 260-264.  Back to cited text no. 4    
5.Schoenfeld A. Pardo J. Engelstein D. Ovadia J. Servadio C. Bladder perforation by an intrauterine device. J Clin Ultrasound 199 L 19:175-177.  Back to cited text no. 5    
6.Dietrick DD. Issa MM. Kabalin JN. Bassett JB. Intravesical migration of intrauterine device. J Urol 1992: 147: 132-134.  Back to cited text no. 6    
7.7. Yalcin V. Dernirkesen 0, Alici B. Onol B. Solok V. An unusual presentation of a foreign body in the urinary bladder: a migrant intrauterine device. Urol Int 1998: 61: 240-242.  Back to cited text no. 7    


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