CASE REPORTS Intravesical migration of a GyneFix ® intrauterine device

A case of intravesical migration of a GyneFix ® intrauterine device (IUD) is described, in which the patient presented with supra-pubic pain and urinary symptoms. The diagnosis was made 34 months after the insertion of the IUD, by ultrasound scan. The GyneFix was removed endoscopically. A description of the GyneFix device, the possible adverse effects and incidences of its complications, the importance of post-insertion follow-up, and the need for awareness of the possibility of intravesical migration are discussed. Case report A 23-year-old nulliparous woman was referred by her general practitioner (GP) with an 18-month history of suprapubic pain. She had been fitted with a GyneFix ® intrauterine device (IUD) in June 1999 (34 months previously). The IUD was fitted uneventfully using a standard technique. Sixteen months post-fitting the patient developed recurrent strangury and urinary frequency, which was refractory to multiple courses of empirical antibiotics. The suprapubic pain worsened over the following months, especially post-micturation. Pelvic examination was normal but failed to locate the threads of the GyneFix. A pelvic ultrasound scan suggested that the coil was lying free in the bladder. The patient underwent cystoscopic and endoscopic removal of the GyneFix; at that time the GyneFix IUD was found adherent to the right lateral aspect of the trigone of the bladder. It was markedly calcified but was removed easily by the endoscopic route. The patient made an uneventful recovery. At the 6-week post-operative review she was asymptomatic.