Design: Case report (surgical video), and literature review

Setting: N/A

Patients or Participants: A case of bladder perforation by a copper IUD.

Interventions: IUD removal with operative cystoscopy

Measurements and Main Results: IUDs are commonly used for pregnancy prevention and management of gynecologic conditions. Perforation is rare (approximately 1 in 1000 cases) and those involving damage to other pelvic organs are reported even more rarely. Here, we present the case of a patient who presented with a new pregnancy, three years after copper IUD placement. Ultrasound demonstrated at least one arm of the IUD perforating into the bladder. Postpartum we performed diagnostic and operative cystoscopy for IUD removal. After postoperative foley catheter decompression, she had a normal cystogram and went on to recover well.

In our literature review of 58 complete case reports from 1974-2004, the median time from IUD placement to diagnosis of perforation was 6.5 years. Management strategies reported include operative cystoscopy with Foley catheter decompression postoperatively, as in the case we present here, frequently (15/58, 26%) with lithotripsy. When the IUD involves intraperitoneal structures or is associated with a large stone, an abdominal cystotomy may be required to remove the device and repair the bladder defect (as reported in 23/58, 40%).

Conclusion: Bladder perforation by an IUD is an uncommon but clinically significant device complication. Clinicians evaluating such cases should be prepared for a variety of operative interventions, most involving cystoscopy with or without lithotripsy and less commonly an abdominal approach involving cystotomy and repair.