MIGRATION OF COPPER T FROM THE UTERUS TO THE URINARY BLADDER WITH CALCULUS FORMATION

MIGRATION OF COPPER T FROM THE UTERUS TO THE URINARY BLADDER WITH CALCULUS FORMATION : Unusual Case Report
A KGvalani, J S Pandya, S Umranikar*
*Resident; Dept of General Surgery, BYL Nair Ch. Hospital, Mumbai Central, Mumbai.
Intrauterine devices are associated with many early and late complications, including perforation and migration into adjacent structures. We report a case of 30 year woman in whom a copper - T eroded in the bladder 6 years after placement of the device.
CASE REPORT

A 30 year female presented to us with complaints of increased frequency of micturition, dysuria, history of interrupted urine stream and occasional terminal haematuria. She had received treatment for urinary tract infection but her symptoms persisted. Her obstetric history was G6 P5 Al with insertion of copper T since 6 years. The patient conceived 3 years after the insertion of copper-T and at full term underwent caesarean section along with tubal ligation. For 3 years after caesarean section and in all 6 years after insertion of the copper-T the patient has remained asymptomatic; till now when she had progressive urinary symptoms since last 3 months. A culture from the midstream urine sample showed plenty of pus cells and a rich growth of E coli. X-ray KUB showed a large radio-opaque vesical calculus. USG pelvis revealed a bladder calculus with a foreign body in its centre, and another foreign body at its lower end. Per vaginal clinical examination did not reveal any threads of copper-T (IUCD), however the vesical calculus was palpable through the anterior fornix. Patient was subjected to suprapubic cystolithotomy and a stone of size 5.2 x 5.0 cm was extracted. The bladder was closed primarily and patient made an uneventful recovery. On fracturing the stone, both the arms of the copper-T along with the thread could be identified. Dalkon Shield and Lippes migration has been reported [1,2,4] IUD is known to slowly migrate into the bladder. [3,5] The commonest presentation is with urinary tract symptoms like recurrent urinary tract infections, haematuria and pelvic pain. Infact vesical stones in a women who has had history of IUD insertion should make one suspect of such possibility.

Slow migration of IUCD from the uterus into the bladder with formation of vesical stone is unusual and this has been reported earlier. [1-5] Migration of Dalkon shield and Lippes loop has been reported. To the best of our knowledge this is the first report of similar migration of copper-T. In fact there is a report where only the thread has migrated and produced a stone formation. [6] Also, a nonabsorbable suture placed near the bladder for stress incontinence can migrate into it leading to urinary symptoms. [7] Patients typically present with irritative symptoms, recurrent urinary tract infections, haematuria and pelvic pain. Vesical calculi are unusual in women and their presence should raise the suspicion of the presence of a foreign body. In a woman with an unretrieved intrauterine device, the possibility of the migration of the device into the bladder should always be kept in mind.

Fig 1:. Plain X-ray pelvis showing radio-opaque calculus with the arm of copper-T lying free within the bladder.

Fig2:. Plain X-ray pelvis showing one arm in the radio-opaque calculus within the bladder.

REFERENCES

Neutz E, Silber A, Merendino VJ. Dalkon Shield perforation of the uterus and urinary bladder with calculus formation case report. Am J Obstet Gynecol 1978; 130 : 848-9.

Saronwala KC, Singh R, Dass H. Lippes loop perforation of the uterus and urinary bladder with stone formation. Obst Gynec 1974; 44 : 424.

Dietrch D, Issa M, Kabalia J, Barret J. Intravesical migration of intrauterine device. The Journal of Urology 1992; 147 : 132-4.

Sasidharan K, Chally R. Intravesical migration of lippes loop with stone formation. Br Journal of Urology 1998; 61 : 363-4.

Woods M, Wise HM. An unusual case of cystolithiasis : A migrant intrauterine device. Journal of Urology 1980; 124 : 720-1.

Cumming GP, Bramwell SP, Lees DAR. An unusual case of cystolithiasis : a urological lesson for gynaecologists. Br J of Obstet and Gynaecol, Jan. 1997; 104 : 117-8.

Cardozo L. Recurrent intra-vesical foreign bodies. Br Journal of Urology 1997; 80 : 687.

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Fig 1:.	Plain X-ray pelvis showing radio-opaque calculus with the arm of copper-T lying free within the bladder.


Fig2:.	Plain X-ray pelvis showing one arm in the radio-opaque calculus within the bladder.