The case of the migrating IUD

A 30-year-old lady presented to the gynaecologist with persistent vaginal bleeding following insertion of an IUD. At the time, abdominal examination was unremarkable and speculum examination revealed normal external genitalia and cervix. A transvaginal ultrasound showed a normal uterus, normal ovaries and no adnexal masses or free fluid. It was assumed that the IUD had fallen out. Around the same time she presented to her GP with a short history of dysuria, intermittent visible haematuria and recurrent urinary tract infections. After initial management in general practice for 12 months, she was referred to the urology department for further investigation. She underwent flexible cystoscopy, which showed the presence of an IUD within the bladder. Under general anaesthesia, it was found that the body of the IUD had penetrated the bladder mucosa and become embedded in the right lateral wall of the bladder. The IUD was markedly calcified but was easily removed endoscopically as a whole unit with grasping forceps. A three-week postoperative cystogram ruled out the presence of a fistula. At the six-week postoperative review she was asymptomatic and well.