title: Safe and cost-effective ultrasound guided removal of retained intrauterine device: our experience.
abstract: OBJECTIVE
  To evaluate the efficacy and difference in cost of ultrasound guided removal of retained intrauterine device (IUD).
  
  
  METHODS
  A total of 23 women underwent ultrasound-guided retrieval of retained IUDs between January 2013 and March 2014. Transvaginal ultrasound was performed in all cases to assess the localization of the IUD. Under transabdominal ultrasound guidance, either the crochet type IUD hook (Gyneas, Goussainville, France) or Alligator forceps were used to grasp the IUD and remove it from the uterine cavity. The costs of the ultrasound guided procedure and the hysteroscopic removal of the IUD were compared.
  
  
  RESULTS
  Twenty-three patients who failed IUD removal in the clinic were referred to our department for ultrasound-guided removal. All patients had an IUD present in the uterine cavity. Eleven patients had Paragard IUDs (48%), eight had Mirena IUDs (35%), three had Lippes loop (13%), and one had a ring IUD (4%). The patients' ages ranged from 20-56 years. The IUDs were in place for 8 months to 23 years. Of the 23 patients with retained IUDs, 19 were successfully removed (83%), and 4 underwent hysteroscopic removal of IUD. The IUD removal cost in the operating room on average was $3562 US dollars and the cost of ultrasound-guided removal was $465 US dollars.
  
  
  CONCLUSIONS
  Retained intrauterine devices with or without strings can often be safely removed in an office-based setting under ultrasound guidance at less cost than in the operating room, even in cases with embedded IUDs.
  
  
  CONCLUSIONS
  Our experience leads us to propose in-office IUD removal under ultrasound guidance as the first line in management of retained IUDs after failed removal by conventional practices. Ultrasound provides numerous advantages including direct visualization in a less invasive manner than hysteroscopy. Three-dimensional imaging can also be used for enhanced perspective.
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami, Miller School of Medicine, 1611 NW 12th Ave., Miami, FL 33136 USA. Electronic address: Uverma@med.miami.edu.
authors.forename: Usha
authors.initials: U
authors.lastname: Verma
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami, Miller School of Medicine, 1611 NW 12th Ave., Miami, FL 33136 USA. Electronic address: FAstudilloDavalos@med.miami.edu.
authors.forename: Fausto E
authors.initials: FE
authors.lastname: Astudillo-Dávalos
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami, Miller School of Medicine, 1611 NW 12th Ave., Miami, FL 33136 USA. Electronic address: Sgerkowicz@gmail.com.
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Gerkowicz
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000191:economics* / Q000379:methods; D005260:Female; D005431:Florida; D013509:Gynecologic Surgical Procedures / Q000191:economics* / Q000379:methods; D006801:Humans; D015907:Hysteroscopy / Q000191:economics; D021621:Imaging, Three-Dimensional; D007434:Intrauterine Devices; D008875:Middle Aged; D018084:Ultrasonography, Interventional / Q000191:economics* / Q000379:methods; D014599:Uterus / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Cost-effectiveness; IUD removal; Missing strings; Retained IUD; Ultrasound guidance