Dados do Trabalho

Título

CYSTOLITHIASIS ASSOCIATED WITH MIGRATION OF INTRAUTERINE DEVICE: A SYSTEMATIC REVIEW

Introdução e Objetivo

Migration of an intrauterine device into adjacent organs is one of the most morbid complications documented for this contraceptive method. The aims of this study were to describe our experience with a rare cases of intrauterine contraceptive device (IUCD) migration to the bladder and to systematically review the literature.

Método

We report two clinical cases of patients aged 30 and 33 years old, presenting with chronic urinary symptoms and recurrent urinary tract infections. Abdominal ultrasounds revealed a hyperechoic lesions in the bladders. Both patients had undergone IUCD insertion 10 years ago. A cystoscopy was performed in each case, revealing a vesical stone fixed to the top of the bladder wall, caused by the intravesical migration of the IUCD. No vesicovaginal fistula formation was observed. In these cases, the IUDs with secondary calculus formation were successfully removed by cystoscopy without complications, and there was no damage to the bladder walls.  Therefore, we designed a systematic review of the literature, using a search strategy with the medical subject heading terms "intrauterine device migration" AND "urinary tract" on the PubMed/Medline database. We also searched the references of the included papers. Studies were included regardless of language or publication type.

Resultados

We screened 92 manuscripts and selected 77, detailing 113 other patients with an intravesical migrated intrauterine device for inclusion, of which 88 cases were included. The mean age of reported cases was 34 years (range: 20-74). More than half (65.91% or 58/88) of the included patients were diagnosed with stone formation, and their missing IUCD was incidentally discovered. Almost half (48.87% or 23/88) of the patients presented with urinary tract infection. Other symptoms observed included suprapubic pain in 47.73% (42/88) of patients, dyspareunia in 4.55% (4/88), and one patient with neoplasia. Over a third (32.95% or 29/88) of the patients were diagnosed as a result of pregnancy. In 61.25% (49/80) of the patients, endoscopic surgery was attempted. The majority of the patients became completely asymptomatic after the treatment.

Conclusão

Although rare, urologists should suspect of a migrated IUCD in patients with unexplained lower urinary tract symptoms and a past history of insertion of this contraceptive method. The results of this review support the surgical removal of the device as a definite treatment, in our experience the cystoscopic removal should be considered a safe and effective approach.