Hysteroscopic management of intra-uterine devices with lost strings

Trivedi, Shubha Sagar; Goel, Madhu; Jain, Sandhi

doi:10.1783/147118900101194652

Cited by 6 publications

(9 citation statements)

References 3 publications

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“…The risk of uterine perforation is minimal when the procedure is performed under direct vision. 5 The present results demonstrate that Macaluso stent removal forceps with Versascope hysteroscopy for the removal of retained IUDs is a simple, safe, effective and acceptable technique. We recommend this procedure as a first-line option for the removal of a retained IUD in a secondary care setting.…”

Section: Discussionsupporting

confidence: 53%

“…We agree with Trivedi et al that blind manipulation with artery forceps, hooks and clamps for IUD retrieval may be potentially dangerous, producing cervical or uterine injuries. 5 Using a hysteroscope to locate and remove IUDs under general anaesthesia is a well-established technique. The risk of uterine perforation is minimal when the procedure is performed under direct vision.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Hysteroscopy and removal of an IUD have been described previously. [3][4][5] However, no forceps has been described in the literature that is suitable for removing the IUD under direct vision via the hysteroscope.…”

Section: Introductionmentioning

confidence: 99%

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A novel device for removal of the retained intrauterine device

Konamme

Auld

Zaidi

2006

j fam plann reprod health care

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Objective To evaluate the efficacy and acceptability of the Macaluso stent removal forceps for removal of retained intrauterine devices (IUDs) under direct vision using a hysteroscope in an outpatient setting.Methods Nineteen consecutive patients with a retained IUD who had been referred from primary care to the gynaecologists at the Conquest Hospital, Hastings, UK were included in the study. Attempts were made to remove the IUDs under direct vision using the Gynecare Versascope ® and Macaluso forceps. ResultsThe procedure was successful in 18/19 (94.7%) patients. The patients tolerated the procedure well and none of them complained of severe pain. ConclusionThis device is simple, safe, effective and acceptable for the removal of IUDs with lost threads. G The Macaluso stent removal forceps is a useful device for hysteroscopic IUD removal.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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A novel device for removal of the retained intrauterine device

Konamme

Auld

Zaidi

2006

j fam plann reprod health care

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“…Studies describing hysteroscopy‐guided removal of retained IUDs showed success rates from 88% to 100%, similar to what we found in our series. This approach is used once an IUD has failed to be extracted by the usual procedures; it usually requires hospitalization and anesthesia and is more expensive and less available in our health care system.…”

Section: Discussionsupporting

confidence: 90%

Ultrasound‐Guided Extraction of Intrauterine Devices With Nonvisible Threads: 254 Consecutive Cases: An Effective, Noninvasive Technique

Kottmann

Valenzuela

Ugarte

et al. 2019

J of Ultrasound Medicine

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Intrauterine devices (IUDs) are among the most efficient and widely used contraceptive methods available. Removal is recommended after a certain time or in some cases when adverse effects are observed. A considerable number of patients have nonvisible guides or “lost threads” on speculum examinations, hindering the extraction. In this article, we report a consecutive series of 254 nonpregnant patients referred to our center after 1 or more failed attempts at IUD removal. We describe a novel ultrasound‐guided approach, using a laparoscopic forceps to safely and effectively remove IUDs in nonpregnant patients.

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“…However, a study by Reiertsen confirmed that whilst reliable in detecting IUDs in utero, ultrasonography is not helpful in detecting cases of penetration into the uterine wall. 6 If routine retrieval methods fail, for the reasons alluded to previously, then most 'apparently lost' IUDs can be both located and then simply and safely removed using hysteroscopic aid. 7 Nevertheless some instances, as the present case illustrates, require more extensive surgery.…”

Section: Discussionmentioning

confidence: 99%

The lost intrauterine device: removal by hysterectomy

Byrd

Slade

2004

j fam plann reprod health care

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A case of migration of an intrauterine device (IUD) deep within the endometrium, presenting as heavy vaginal bleeding and abdominal pain, is discussed. The IUD had been in situ for 31 years. Standard retrieval techniques failed and removal necessitated hysterectomy. The complications of 'lost IUDs' are discussed and the need to enquire about removal in all women on approaching the menopause is emphasised. Case reportA 55-year-old woman presented to the gynaecology outpatients department with an 8-month history of painful vaginal bleeding since commencing hormone replacement therapy (HRT). She had an intrauterine device (IUD) in situ that had been inserted some 31 years previously.On speculum examination the IUD threads were not visible, and simple retrieval failed. HRT was stopped and hysteroscopy, curettage and removal of the IUD were arranged, under general anaesthesia. At hysteroscopy the IUD was not seen within the cavity, and the curettings were unremarkable. An X-ray reported that the IUD was sited 'within the pelvis'.On review 1 month later the patient was well and reported no further bleeding or abdominal pain. In view of this fact she was not keen to pursue further surgery. However, because of severe vasomotor symptoms she was recommenced on HRT.At review 3 months later, however, the patient reported unacceptable vaginal bleeding and abdominal pain following the recommencement of HRT. It seemed possible that the lost IUD was actually lying deep within the endometrium, provoking a reaction within the endometrium and the symptoms described. This possibility was discussed with the patient who opted to undergo hysterectomy.Surgery was undertaken. Following hysterectomy the removed uterus was dissected. The IUD was located deep within the endometrium as anticipated (Figures 1 and 2). The patient made an uneventful recovery and was commenced on oestrogen-only HRT. At review 2 months later she was well. DiscussionAn IUD is a safe, effective and economical method of contraception, used by more women worldwide than any other reversible method of birth control. 1 Longer-term use of IUDs may be associated with problems. An IUD that remains in situ beyond the menopause can cause both vaginal bleeding and difficulties in removal, as the present case clearly demonstrates.Bleeding problems can be due to erosions of the surface epithelium and micro-thrombosis in the underlying endometrial capillaries. The perimenopausal endometrium is at increased risk. 2 Bleeding may also occur because the IUD evokes both acute and chronic inflammatory responses within the endometrium. 3 It has been postulated that, over a prolonged period, this same inflammatory response could predispose to endometrial carcinoma (akin to chronic irritation and vulval carcinoma). The available data are, however, for the most part reassuring, suggesting even a possible protective effect. This may be either through the generation of an inflammatory response, which leads to early elimination of hyperplastic epithelial cells, or more complete...

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Hysteroscopic management of intra-uterine devices with lost strings

Abstract: SummaryWe report a series of 38

Cited by 6 publications

References 3 publications

A novel device for removal of the retained intrauterine device

A novel device for removal of the retained intrauterine device

Ultrasound‐Guided Extraction of Intrauterine Devices With Nonvisible Threads: 254 Consecutive Cases: An Effective, Noninvasive Technique

The lost intrauterine device: removal by hysterectomy

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