ABSTRACT

Aim: To diagnose and to find a management strategy for urological complications of Copper-T.

Method: It was a descriptive study conducted from May 2016 to May 2020 in Jinnah Hospital and KEMU/Mayo Hospital Lahore. The study was conducted in collaboration with Gynea/Obs department of both hospitals. Ethical issues and written informed consent were taken into account. Diagnosis was made on the basis of history, abdominal and PV examination, routine lab tests, urine culture and sensitivity, ultrasound KUB, X-ray KUB, CT-/MRI KUB, Transvaginal Ultrasonography, hysterosylphingography and cystoscopy. All relevant data was recorded.

Results: 7 cases of migrated Copper-T into the urinary bladder were diagnosed and included in the study. Age range was 21-38 years. In all cases IUCD was copper-T, as it is most commonly used in Pakistan. 1/7 (14.2%) cases was from Mayo Hospital, rest of 6/7 (85.7%) cases were from peripheral hospitals. In-Situ duration of copper-T was 1-8 years. In 2/7 (28.5%), no stone or encrustation was found. In 5/7 (71.4%) cases, encrustation or stone formation was found on copper-T. In 5/7 (71.4%) cases Copper-T was removed endoscopically. In 2/7 (28.5%) Copper-T was in embedded in bladder wall and the size of the stone formed over it was large so open cystostomy was needed to remove the stone and the Copper-T. History of previous C-Section found in 6/7 (85.7%) cases. In only 1/7 (14.2%) cases, we found history of occasional episodes of urinary incontinence.

Conclusion: Copper-T insertion is still most popular cost effective with least complications mechanical method of reversible contraception worldwide. Penetration into the urinary bladder is rare, but is there. Woman who have undergone Copper-T insertion with previous history of C-Section are more prone to get their Copper-T migrated into the urinary bladder, so a careful follow up is needed in such cases. High index of suspicion is needed in diagnosis of such cases. Cystoscopic retrieval is safe, effective and minimal invasive approach is the main stay of treatment to manage a migrated Copper-T. However removal by open cystostomy can be adopted in more complicated cases.

Keywords: Copper-T, IUD, Uterine Perforation, Litholapaxy, Endoscopic Retrieval, Cystostomy