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Abstract

Intrauterine contraceptive devices (IUCDs) are widely used, effective, and reversible, but rare complications include uterine perforation with extrauterine migration. Intravesical migration is uncommon and may serve as a nidus for vesical calculus formation, presenting with persistent lower urinary tract symptoms (LUTS) that are often misattributed. Objective: To describe the presentation, diagnostic pathway, and endoscopic management of an intravesically migrated IUCD with secondary bladder calcifications, emphasizing key follow-up and imaging considerations. Methods: This single-patient case report was conducted in the Department of Urology at Dr SAM CHB. The observation period spanned the index urology evaluation through a 1-week postoperative follow-up. The clinical data included a comprehensive history, a thorough examination, and relevant imaging studies. The diagnostic work-up consisted of a plain X-ray of the kidneys, ureters, and bladder (KUB), which revealed a metallic foreign body projected over the bladder, and ultrasonography, which demonstrated intravesical calcifications. The patient underwent diagnostic cystoscopy followed by same-session cystoscopic extraction of the IUCD with removal of adherent calcifications. Peri-operative outcomes and early symptom resolution were recorded. No statistical analysis was applicable due to the single-case design. Results: A 32-year-old woman with a 4-year history of dysuria, frequency, urgency, and intermittent fever had an IUCD inserted 5 years earlier that was presumed expelled after abnormal uterine bleeding; she subsequently conceived and delivered vaginally, with LUTS persisting postpartum. X-ray KUB identified a T-shaped metallic foreign body within the pelvis consistent with an IUCD; ultrasound confirmed intravesical calcifications. Initial management elsewhere was planned as an open cystolithotomy for presumed primary vesical calculus. On referral, cystoscopy revealed a partially encrusted IUCD within the bladder. Complete endoscopic removal of the IUCD and attached calcifications was achieved in a single session without complications. At 1-week follow-up, the patient reported complete resolution of LUTS. Conclusion: Intravesical IUCD migration, though rare, should be considered in women with unexplained LUTS and a history of IUCD insertion, especially when expulsion is suspected. Early use of plain radiography and targeted cystoscopy can expedite Diagnosis and enable minimally invasive, single-stage endoscopic removal, avoiding unnecessary open surgery. Routine post-insertion follow-up and prompt imaging when strings are not visualized or expulsion is suspected are essential to prevent delayed morbidity.