Intrauterine device visualized as extrinsic bladder mass on cystoscopy

Excerpt

A 45-year-old gravida 3 para 3 woman was noted to have an extrinsic bladder mass impinging on the bladder urothelium on cystoscopic assessment for longstanding bladder pain syndrome. Her past surgical history was significant for one cesarean section and a hysteroscopic endometrial resection for heavy menstrual bleeding. Due to recurrence of menorrhagia 4 years after endometrial ablation, she had a levonorgestrel intrauterine system inserted in the office setting without apparent complications and with minimal discomfort. This provided excellent menstrual control for 1 year, but since she had increasing urgency, frequency, and suprapubic pain with a full bladder, cystoscopy was performed to assess for a potentially treatable etiology and for hydrodistension. An extrinsic mass appeared to be protruding from the posterior bladder wall above the level of the trigone and was increasingly prominent with bladder filling. Given her worsening pain symptoms and visualization of the mass on cystoscopy (Fig. 1a), she chose to have the intrauterine device (IUD) removed. The IUD strings were easily visualized on speculum examination and the IUD was removed in the cystoscopy suite immediately following cystoscopy, without significant discomfort or physician effort. Immediately following removal, second-look cystoscopy (Fig. 1b) showed resolution of the mass. Saline infusion sonography (Fig. 2) was performed 3 weeks after IUD removal and a myometrial niche at the level of her previous cesarean section scar was noted. The thickness of the myometrium between the endometrial cavity and the bladder at the niche was 4 mm, and this was felt to be the most likely site of IUD perforation. Two months following IUD removal, she was reassessed and reported a significant improvement in urgency, frequency and suprapubic pain.

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