Rebecca Locke, Presenter: Nothing to Disclose

Gareth Edward Lewis MBBS, MRCS, Abstract Co-Author: Nothing to Disclose

Jonathan Richenberg MRCP, FRCR, Abstract Co-Author: Nothing to Disclose

Retrieval of intrauterine devices with ‘lost’ strings is most commonly achieved by hysteroscopy and often involves general anaesthesia. At our institution we offer interventional radiological retrieval using fluoroscopic guidance as an out patient procedure. To our knowledge little published data is available on this technique. We retrospectively review and discuss 67 cases performed between January 2008 and April 2011.

If the patient has regular withdrawal bleeds the procedure is performed within the first 14 days of her cycle. If amenorrheoic the patient performs a negative pregnancy test, abstains from sexual intercourse for 6 weeks and is required to produce a second negative pregnancy test on the day of the procedure. The patient is consented in the radiology interventional suite. Following spot fluoroscopic confirmation of the IUD within the pelvis, a speculum is inserted and having located the cervix a tulip snare is introduced. Under screening the stem of the IUD is snared and manipulated. Removal of the complete IUD is confirmed post procedure. The speculum is left in place for 2-5 mins to check for local bleeding. All procedures have been performed using Philips (2006) C-arm.

During 3 years and 1 month, 67 fluoroscopic IUD retrieval procedures were performed of which 60 IUDs (89.6%) were successfully retrieved. Screening times were recorded in 66 patients and averaged 4mins 53secs with a range of 1 second (strings visible) to 26mins 31secs. Excluding the failed retrieval procedures the average screening time was 4mins 18secs. Reasons for retrieval failure included spasm, vasovagal symptoms, tortuous cervix limiting os accessibility, fibroid uterus, low IUD position and extra uterine migration. There have been no reported complications.

We discuss the benefits and disadvantages of this procedure as well as what experience has taught us. We believe there is a role for radiological intervention using fluoroscopy to retrieve ‘lost’ IUDs. The dose burden is offset by avoidance in the majority of women of a general anaesthetic and day surgery, increase in patient satisfaction and reduction in cost.

In the UK 4% of fertile women use the intrauterine contraceptive device. Difficulty in removal often necessitates retrieval via hysteroscopy. Fluoroscopy guided removal is a less invasive alternative.

Locke, R, Lewis, G, Richenberg, J, Outpatient Retrieval of Intrauterine Devices under Fluoroscopic Control.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002703.html