A Woman with Two Uteruses Believed Her IUD Was Removed Decades Ago, but It Was Squeezing Her Ureter

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The case, published Oct. 7 in Frontiers in Medicine by a urologist and a gynecologist at Changde Hospital, Xiangya School of Medicine, Central South University, describes a ring-shaped intrauterine device (IUD) sitting completely outside the woman’s uterus. It was lodged against the lower end of her right ureter, the tube that carries urine from the kidney to the bladder, which had narrowed into a fixed stricture. Above the blockage, her ureter and kidney were severely swollen.

Adding to the puzzle, the woman has uterus didelphys, a congenital condition in which a person develops two separate uteruses instead of one.

The IUD was placed at a local hospital more than 20 years before her latest admission. At that point, no one knew she had two uteruses.

Two to three years later, she became pregnant unexpectedly. A second hospital then discovered the double uterus, performed an induced abortion, and carried out an IUD removal. Those records no longer exist, so the authors could not confirm whether the device actually came out intact, and no later imaging was checked. The device’s model and material are unknown.

The authors put their central lesson bluntly: “A history of IUD removal should not be treated as proof of device absence when intact retrieval is undocumented.”

The woman had roughly a year of right flank pain and frequent urination. She received repeated treatment for a presumed urinary infection and possible genitourinary tuberculosis without lasting relief, and she had also been taking the antibiotic levofloxacin that she obtained elsewhere.

Her tests were murky. Her urine showed white blood cells, but the culture grew nothing. TB-specific tests were negative, and an infectious disease review found the evidence insufficient for active TB. Her serum creatinine, a kidney function marker, was normal.

Imaging finally cracked the case. An intravenous urogram showed impaired drainage from the right kidney and a metal device in the pelvis. CT revealed severe swelling of the right ureter and kidney, called hydroureteronephrosis, with focal narrowing of the ureter right next to the device. A 3D transvaginal ultrasound confirmed two uterine cavities, with the IUD-like object outside both. Retrograde pyelography, an X-ray of the urinary tract using dye injected from below, placed the metal ring against the lower right ureter.

Surgeons operated through a right lower abdominal incision without entering the abdominal cavity. They found the intact ring pressing on the ureter from the outside, about 1 centimeter of rigid, narrowed ureter, and marked swelling above it. A small stone, about 0.5 by 0.6 centimeters, had formed on the device.

Taking out the ring did not reopen the ureter. The team cut out the scarred segment, stitched the healthy ends back together over a temporary internal stent, and removed the stent two months later. Pathology showed chronic inflammation with no signs of tuberculosis.

Six months after surgery, CT showed no remaining metal and marked improvement in the swelling of the right kidney’s drainage system, with no recorded complications. The authors note this is short-term follow-up and that separate function measurements for each kidney were not available.

IUDs are among the most effective forms of birth control, and serious complications are uncommon. In the large European EURAS-IUD study of more than 61,000 women, uterine perforation occurred in roughly 1 per 1,000 insertions, and the U.K. medicines regulator highlighted the study’s finding that risk was higher when insertion took place during breastfeeding. Interim data summarized by New Zealand’s regulator, Medsafe, showed the same pattern.

Reaching the urinary tract is rarer still. A review in the Journal of Clinical Medicine published in 2024 gathered 115 published cases of IUDs that migrated into the urinary tract. Most involved the bladder, and only seven involved the ureters. In cases reporting the timing, devices had been in place for an average of about eight years.

The Chinese authors stress that IUD-related ureteral obstruction is an established complication rather than a new discovery. They also describe the double uterus as anatomic context rather than a proven cause, and say they cannot determine when or how the ring escaped, or prove that it alone caused the stricture. A double uterus often causes no symptoms, which helps explain why it went unrecognized when her IUD was placed.

Their practical advice targets clinicians: when a past removal cannot be verified, ultrasound or a pelvic X-ray can show whether a device remains, and cross-sectional imaging such as CT can map its position against nearby organs. Women who are unsure whether an old IUD was fully removed can raise the question with a clinician.

Intravenous urography first showed a metal device in her pelvis. CT, 3D ultrasound and retrograde pyelography then pinpointed the ring outside both uteruses, against the lower right ureter.

Did removing the device fix the blockage?

Not by itself. The ureter had scarred into a fixed stricture, so surgeons removed the narrowed section and reconnected the ureter.

Is IUD migration into the urinary tract common?

No. Uterine perforation occurs in roughly 1 per 1,000 insertions in large studies, and migration to the ureter is far rarer, with only seven ureteral cases among 115 in a 2024 review.

That has not been shown. The authors describe uterus didelphys as anatomic context and say the timing and mechanism of the device’s displacement remain unknown.

What should someone unsure about an old IUD do?

Talk with a clinician. Simple imaging, such as an ultrasound or a pelvic X-ray, can show whether a device remains.