Abstract
BACKGROUND: Uterine perforation with intravesical migration is an exceedingly rare complication of intrauterine device (IUD) use. Its non-specific symptomatology often leads to delayed diagnosis, while the presence of a uterine scar, such as from a prior cesarean section, may significantly increase the risk. CASE PRESENTATION: A 38-years-old woman (gravida 5, para 2) with a history of two cesarean sections presented at 8 weeks of gestation for termination of pregnancy. A V-shaped copper IUD had been placed over 10 years earlier. Notably, she reported a 1-year history of intermittent urinary frequency and gross hematuria, which were partially relieved by hydration. Pelvic computed tomography (CT) demonstrated that the IUD had perforated the lower anterior uterine wall at the site of the previous cesarean scar, with one arm penetrating into the bladder lumen and becoming encased by a 5 mm × 3 mm × 2 mm calculus. INTERVENTION AND OUTCOME: Under general anesthesia, the patient first underwent an uncomplicated hysteroscopic abortion. This was followed by cystoscopy, which confirmed the intravesical IUD arm embedded in the stone. The entire complex was successfully removed intact via transurethral extraction using grasping forceps, without the need for lithotripsy. A urethral catheter was left indwelling postoperatively for 4 weeks (protocol target 2-3 weeks; delayed at patient's request) to facilitate bladder healing. Upon its removal, the patient's voiding symptoms and hematuria had completely resolved. At 4-months follow-up, she remained asymptomatic. CONCLUSION: This case highlights that a prior cesarean section scar is a paramount risk factor for late-onset IUD migration into the bladder. Unexplained lower urinary tract symptoms in women with this history warrant prompt investigation with cross-sectional imaging such as CT. When the migrated IUD is associated with a small, manageable stone, direct cystoscopic retrieval is a viable and effective minimally invasive treatment option.