膀胱內子宮避孕器結石

劉致毅^1,2、王巽玄^1,2、李永進^1,2

¹高雄市立小港醫院泌尿科；²高雄醫學大學附設中和紀念醫院 泌尿部

Intrauterine Device Calculus in the bladder

Chih I Liu^1,2,  Hsun Shuan Wang1,2,  Yung Chin Lee^1,2

Division of Urology,Kaohsiung Municipal Siaogang Hospital,Taiwan¹;

Department of Urology,Kaohsiung Medical University Hospital,Kaohsiung Medical University²

Present Illness: A 48-year-old female patient presented to the urological clinics for the chronic urinary symptoms with frequency, gross hematuria and voiding pain. Urine analysis showed pyuria and hematuria. Several episodes of recurrent UTIs annually were noted.

Image: Ultrasonography revealed an immovable bladder stone, size in 3.3cm, hung on the anterior bladder wall. Abdominal X-ray showed a round pelvic calcification and two intrauterine devices (IUDs), coiled and T-shaped, in the pelvis. Abdominal CT scan revealed a spherical bladder stone with the two tails throughout the bladder wall into the perivesical region.

Operation: Cystoscopy revealed the bladder stone and the two whitish plastic frames embedded deeply in the stone hanging on the anterior bladder wall. With the holmium laser cystolithotripsy, a cooper T-shaped IUD penetrated throughout the bladder was identified and then removed by the forceps. Minimal bladder wound was noted after the IUD removal. Foley catheterization was indwelled for 5 days. The patient had neither further urinary symptoms nor UTI in the consecutive follow up.

Conclusion: We presented a case of 48-year-old female patient with intrauterine devices migration.  The pathophysiologies of the bladder stones are mainly the bladder outlet obstructions due to the anatomical anomalies or the functional urinary dysfunctions. The incidences of the bladder stones are much higher in the male patients due to benign prostate enlargement in the aging male. For the unusual female bladder stones, the foreign bodies in the bladder, such as the surgical stitches, meshes or the IUDs must be contemplated. Detailed reviews for the histories and the examinations are essential for the differential diagnosis.