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BACKGROUND: An intrauterine device (IUD) is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women. However, an IUD may cause complications due to placement time, intrauterine pressure and other factors. Ectopic IUDs are among the most serious complications. Ectopic IUDs are common in the myometrium and periuterine organs, and there are few reports of ectopic IUDs in the urinary bladder, especially in the anterior wall. CASE SUMMARY: A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography (CT) examination. The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain, accompanied by frequent urination, urgency, dysuria and other discomfort. Ultrasound examination revealed foreign bodies in the bladder cavity, with calculus on the surface of the foreign bodies. CT revealed a circular foreign body on the anterior wall of the urinary bladder, suggesting the possibility of an ectopic IUD. After laparoscopic exploration, an annular IUD was found in the anterior wall of urinary bladder, and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity. The IUD and calculus were successfully and completely removed. The patient recovered well after surgery. CONCLUSION: Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs. The IUD is located in the urinary bladder and requires early surgical treatment. The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer, the situation of complicated calculus, the situation of intravesical inflammation and medical technology and equipment.
RESUMO
OBJECTIVE: To explore the existence of bladder smooth muscle autophagy and its function in cyclophosphamide (CYP) -induced cystitis. METHODS: A total of 30 Sprague-Dawley rats were randomized into control (n = 6) and experimental groups (4 h, 48 h, 72 h, 96 h, n = 24) . The experimental group received a single intraperitoneal injection of 150 mg/kg CYP in 0.6 ml saline while the control group had the same volume of saline injection. The changes of microtubule-associated protein light chain 3 (LC3), interleukin-6 (IL-6), IL-1ß and tumor necrosis factor-alpha (TNF-α) proteins in bladder muscular layer were measured with Western blot. Co-location of LC3 and alpha-small muscle action (α-SMA) was detected with double-labeled immunofluorescence. Autophagic vacuoles were observed with electron microscopy. The changes in bladder inflammation were measured by hematoxylin and eosin staining. RESULTS: Autophagy was confirmed in detrusor myocytes with electron microscope, LC3 Western blot and double-labeled immunofluorescence. As compared with the control group, the expression level of LC3 in experimental groups decreased (0.08 ± 0.01 vs 0.13 ± 0.01, P < 0.05) at 4 h and increased 1.19, 0.75 and 0.20 fold (0.29 ± 0.04 vs 0.13 ± 0.01, P < 0.05; 0.23 ± 0.03 vs 0.13 ± 0.01, P < 0.05;0.16 ± 0.03 vs 0.13 ± 0.01, P > 0.05) at 48, 72 and 96 h respectively.Electron microscopy and double-labeled immunofluorescent also supported the above change of LC3 by Western blot.In addition, as compared with the control groups, IL-6, IL-1ß and TNF-α and bladder histological scores of bladder muscular layer significantly increased in experimental groups (all P < 0.05) . CONCLUSIONS: Autophagy exists in bladder smooth muscle. In cyclophosphamide-induced cystitis, bladder smooth muscle autophagy activation may not be sufficient to protect bladder muscle layer inflammation in rats.