[Clinical evaluation of hysteroscopy in management of missing and difficult-to-remove IUDs]

32 cases of missing and difficult-to-remove IUDs were examined by hysteroscopy, using carbon dioxide as the medium to distend the uterine cavity. Of these, 6 cases with IUDs or retained broken pieces previously missed by fluoroscopic examination were detected by hysteroscopy; 3 cases previously reported as having IUDs by fluoroscopic examination, which, however, failed to be removed after 3-5 trials in other hospitals (with 1 case resulting in perforation of the uterus and serious infection) were diagnosed by hysteroscopy to have IUDs translocated outside the uterus. Based on the relationship between IUDs and the uterine cavity established through hysteroscopic examination, the 32 cases in the present study could be classifed chiefly into 4 groups: IUD lying free within the uterine cavity (16 cases), IUD embedded in uterine wall (9 cases), retained broken pieces (4 cases), and IUD outside the uterus -- translocation of IUD (3 cases). after locating the IUD hysteroscopically, all but 1 of the free or embedded IUDs or retained broken pieces were successfully removed with a miniature hook or small grasping forceps. The only case in which the IUD could not be removed by hook or forceps was one having most of the IUD embedded deep into the myometrium. The translocated IUDs were removed by laparotomy. Findings mentioned above indicate that hysteroscopy is rather safe, not very unpleasant to the patient, and very helpful for the accurate localization of IUDs, thus facilitating their removal, particularly in cases of retained broken pieces of IUDs.