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Migration of an intra-uterine contraceptive device into the bladder with calculus formation: A case report
*Corresponding author: Saburi Oyewale, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria. saburioyewale@yahoo.com
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Received: ,
Accepted: ,
How to cite this article: Oyewale S. Migration of an intra-uterine contraceptive device into the bladder with calculus formation: A case report. RMC Glob J. 2026;2:87-90. doi: 10.25259/RMCGJ_7_2026
Abstract
The intrauterine contraceptive device (IUCD) is one of the most common contraceptives available for women of reproductive age. However, its migration into adjacent viscera is a rare complication that predominantly occurs in resource-poor settings. We present a 42-year-old woman who had an IUCD inserted seven years before the presentation and subsequently had a neglected, missing IUCD. She had irritative lower urinary tract symptoms for 6 months and eventually underwent urethrocystoscopy and open retrieval of the IUCD, which had a secondary calculus formation. This case report highlights the need for proper training of healthcare workers in developing countries to ensure correct IUCD insertion. In addition, patients who cannot palpate the IUCD strings should undergo prompt radiologic investigations to prevent its migration into adjoining viscera.
Keywords
Bladder stones
Calculus
IUCD
Migration
Vesicolithotomy
INTRODUCTION
The intrauterine contraceptive device, excluding China, is one of the most used reversible contraceptives worldwide.1 In Nigeria, the most used contraceptives are the bill and withdrawal methods.2 The incidence of migration of IUCD (intrauterine contraceptive device) is < 4 per 10003, and the various sites of migration could be sigmoid colon, ovary, peritoneum, and the bladder. However, the incidence of intravesical migration of IUCD with secondary calculus formation is rare worldwide.4,5 The aim of this presentation is to ensure a high index of suspicion of uterine perforation of IUCD in patients who cannot palpate the strings of the device. This is coupled with the fact that the formation of calculus around an IUCD is rare worldwide.4
We present an incidental finding of a migratory IUCD into the bladder in a 42-year-old woman who presented to the surgical outpatient department.
CASE REPORT
Patient’s clinical information
S. B. is a 42-year-old woman, a trader residing in Ilorin, Nigeria. She presented to the surgical outpatient department with a six-month history of increased urinary frequency. There was associated urgency, nocturia, and dysuria. There was no weak urine stream, intermittency, straining on micturition, or incomplete bladder emptying. There was no loin pain, swelling, hematuria, or suprapubic pain or swelling. She did not have nitrituria or passage of stones in the urine. There was no fever, anorexia, or weight loss. The symptoms were not resolved with antibiotic use. She had an IUCD inserted 7 years prior to presentation at a peripheral health center. She stopped feeling the strings of the device eight months after insertion. She was later presented at the family planning clinic, where she was told that ‘it might have fallen out’. She had used a combined oral contraceptive pill for approximately 1 year before the IUCD insertion. She had no symptoms until the onset of irritative LUTS. She had no comorbidities.
Clinical findings
She was not pale, anicteric, cyanosed, well hydrated, or had pedal edema. The vital signs were normal. The abdomen was full and moved with respiration. There was no renal angle tenderness, no palpable organomegaly or ascites, and the bowel sound was normoactive.
Diagnostic assessment
A pelvic ultrasound revealed a 4 cm echogenic curvilinear structure in the bladder, casting a posterior acoustic shadow. There was no sonographic evidence of an IUCD in the endometrium. Pelvic radiograph showing a transversely lying IUCD encased by a stone [Figure 1].
Urine microscopy, culture, and sensitivity yielded Candida albicans, and urinalysis showed 2+ of protein and 1+ of both blood and leukocytes. The electrolytes, Urea, Creatinine, and Full Blood Count were essentially normal.
Missing IUCD? migrated into the bladder. A possible differential diagnosis of urinary tract infection was also considered. There were no diagnostic challenges or financial constraints.
Therapeutic intervention
She underwent urethrocystoscopy, which revealed a rough, yellowish bladder stone (5 cm × 3 cm) encasing a migrated IUCD and gross inflammation of the bladder [Figure 2]. All attempts at cystoscopy were abortive. Subsequently, an open vesicolithotomy was performed [Figures 3-5].
She was discharged home six hours post-surgery with a urethral catheter, oral antibiotics, and oral anti-fungal agents. She was seen in the SOPD 9 days later, and the skin stitches were removed. The wound edges were well apposed, with no discharge or other adverse outcomes. The urethral catheter was removed for 14 days postoperatively.
DISCUSSION
At the University of Ilorin Teaching Hospital, the rate of missing IUCD was found to be less than 1%6, and most of these devices were inserted by trainees. The IUCD is one of the most widely used reversible contraceptives in most countries, with an estimated 80 million women using it globally.7 Uterine perforation, septic abortion, and pelvic abscess are a few of the many problems linked to IUCD.8,9
When the IUCD string cannot be palpated close to the cervix, missing IUCDs should be assessed using radiological investigations. For this index patient, instead of obtaining a pelvic ultrasound scan, the healthcare professionals suggested that the device may have fallen off, and she did not have a follow-up.
The pathogenesis of uterine perforation can be primary or secondary. Primary expulsion occurs at the time of insertion and is characterized by pelvic pain and bleeding. The causes of this could be due to poor technique of insertion, the type of IUCD inserted, the skill and experience of the healthcare provider, and the anatomy of the uterus. The Dalkon Shield IUCD was associated with an increased risk of uterine perforation and was withdrawn from the market in the early 1970s. The risk factors for extra-uterine migration include abnormal uterine position, previous abortion, lactation, uterine contractions, and cervical surgeries.
In natural history, lower urinary tract symptoms develop between 3 months and 5 years.5 This index patient developed lower urinary tract symptoms after 7 years of insertion (performed at a peripheral center). This was associated with worsening symptoms despite the use of antibiotics. Eventually, the patient’s urine culture yielded Candida albicans, which might have been due to repeated antibiotic use.
Calculus formation may occur during prolonged intravesical migration. This may be found in 50% of such cases.10 The extent of stone formation is variable, and it is not dependent on its duration in the bladder. In the index patient, the migrated IUCD was encased in calculus and embedded in the posterior wall of the bladder. This necessitated retrieval by open cystolithotomy following a failed cystoscopy. The patient was satisfied with the resolution of her symptoms.
In patients who could not palpate the string of an IUCD and for whom there was no expulsion of the device, a transvaginal ultrasound should be requested. If this is inconclusive, abdominal radiography in the lateral and anteroposterior views should be used to appropriately locate the device. This patient would have benefited from this approach of management instead of the false reassurance given after the strings of the device could not be palpated. The limitation of this case report is that patient management was not possible through laparoscopic retrieval of the retained IUCD via a minimally invasive approach.
CONCLUSION
Migration of the IUCD into the bladder is a possible complication that must be considered, especially when the string cannot be felt by the patient in the vagina. All family planning providers should screen potential users, insert the IUCD correctly, ensure appropriate surveillance, and follow up with patients on the IUCD.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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