Intrauterine copper devices have been in use for around five decades now. Their relative safety and longevity are the most important factors for their preference over other contraceptive measures. As with any other treatment or intervention, IUCD also brings various unfavorable side effects. A few of the potential serious side effects of IUCD include dysmenorrhoea, ectopic pregnancy, pelvic infection, abscess, and septic abortion [3,4,5]. Transmigration of IUCD into adjacent structures is another side effect that is extremely rare. Typically, migration occurs into the surrounding organs, most commonly into the bladder, but few cases of IUCD migrating into the peritoneum, omentum, and colon are also reported in the literature [4, 6, 7]. In our case, IUCD migrated into the urinary bladder.
Expertise and skills play a significant role in the development of uterine perforation by an IUCD migration. Most of the migrations (86%) result during the procedure of insertion of the intrauterine copper device. A study emphasized the importance of skills by determining the chances of perforation. It showed that doctors with experience of fewer than ten device insertions were more likely to report uterine perforation than those with more experience [8].
Foreign bodies in the bladder can cause vesical calculus formation. Though rare, intrauterine copper devices can act as a nidus to form bladder stones. Calcium accumulation on the intrauterine copper device is also believed to play a role in the development of stones [9, 10]. Vesical calculi are relatively rare in women, as typically they are associated with obstructive urinary symptoms in men. The presence of bladder stones in females should bring suspicion of a foreign body such as IUCD in our patient [4].
Classically, patients present with symptoms like hematuria, irritative voiding symptoms (increased urinary frequency), suprapubic pain, and urinary incontinence [3]. Similarly, our patient had suprapubic pain, hematuria, and increased urinary frequency. Due to the overlapping of symptoms with those of cystitis, these patients should be managed with extreme care. Investigations like USG and X-rays can be beneficial in confirming the suspected diagnosis of migrated IUCD. Timely diagnosis can avoid unnecessary use of antibiotics as many of such patients get multiple antibiotic courses before the actual diagnosis is reached [11]. This is true in our case, as the patient took various antibiotics before she presented to us.
According to the International Planned Parenthood Federation, any perforated IUCD should be immediately removed [12]. It is even more critical if migration occurs into the urinary bladder with the potential of stone formation. Various methods like vaginal or suprapubic cystotomy can be used to remove IUCD alongside the adherent stone [1]. Literature review shows methods like cytoscopic removal, laser lithotripsy and even laparotomy have been used to remove migrant IUCD. However, open cystolithotomy is the most commonly used procedure [13]. Similarly, open cystolithotomy through a suprapubic approach was preferred in our case due to the significantly larger stone.
