Migration of an intrauterine device causing severe hydronephrosis progressing to renal failure

Abstract

Rationale:Intrauterine device (IUD) is commonly used in China. Its complications include uterine perforation, IUD ectopic migration, etc. However, a migrated IUD rarely leads to renal failure.Patient concerns:IUD insertion in the patient was followed by unexplained pain in the left renal area, without bladder irritation or dysuresia.Diagnoses:Hydronephrosis, renal failure, migrated IUD.Interventions:The patient underwent laparoscopic and retroperitoneoscopic left nephrectomy, partial ureterectomy, and migrated IUD extraction.Outcomes:No complications were found after 1 year of follow-up.Lesson:An IUD should be placed by an experienced doctor. If conditions permit, it is best to perform the procedure under the guidance of ultrasound. The patients should be advised to undergo regular check-ups after the procedure. If necessary, abdominal color Doppler examination should be performed. Importantly, patients with IUD pregnancy must be reviewed.

Management Challenges of Ureteral Foreign Body-Clinical Vignette and Review of Literature

“…Li et al reported a laparoscopic left nephroureterectomy for a nonfunctioning kidney after lodging an intrauterine contraceptive device in the left distal ureter for 3 years. 11 Case reports by Sener et al 1 and Miraliakbari et al 5 demonstrated segmental ureterectomy of the stenotic segment along with ureteroneocystostomy and removal of the foreign objects. Chen et al 9 showed a failed ureteroscopy followed by spontaneous passage of an endoscopic glue material.…”

“…[1][2][3][4] Migration or erosion of suture materials, mesh, Hemo-Lok clips, metallic clips, vascular graft materials, coils used for embolization, guidewire introducer, suprapubic catheter, intrauterine contraceptive device into the ureters have been reported in the literature. [1][2][3][4][5][6][7][8][9][10][11][12][13] In some clinical scenarios, symptoms such as flank pain, urinary tract infections, and lower urinary tract symptoms (frequency, hematuria, and dysuria) may be an indication for a foreign body erosion into the urinary tract. 3,4,9 extraction of such foreign bodies may also depend on the anatomical location, size, shape, and mobility of the object.…”

“…4,5,7,8,10 In cases of large foreign body, ureteral stenosis, nonfunctioning kidney requiring segmental ureterectomy + ureteroneocystostomy or nephroureterectomy; open or laparoscopic surgery may be feasible. 5,6,[9][10][11] We reviewed the literature to assess the challenges in the management of ureteral foreign body and compared the outcome using a clinical vignette of a 48-year-old female with metallic clip in the left proximal ureters following laparoscopic left hemicolectomy managed successfully with ureteroscopic holmium laser fragmentation and extraction with grasping forceps.…”

Spontaneous Urinoma Without Trauma or Obstruction in a 64-Year-Old Female

“…To date, there is no known reason for the patient's urethral injury, making this a case of truly spontaneous rupture. Any conclusion based upon available studies and history would be purely speculative [7][8][9].…”

Intrauterine device found in an ovarian tumor

“…[ 13 ] Other unusual sites of IUD migration have been reported, including bladder, ureter, and inguinal region. [ 8 , 18 , 19 ] Patients can be asymptomatic or have serious complications, such as fistulas, intra-abdominal abscesses, intestinal perforations or renal failure. [ 13 , 18 , 20 , 21 ]…”