Minimally Invasive Approach to Intrauterine Device Migration Into the Bladder Using Holmium Laser

The intrauterine device (IUD) is a widely utilized method of contraception known for its high efficacy, safety profile, and long-term effectiveness. Despite its favorable characteristics, rare but potentially serious complications may occur, such as uterine perforation and device migration into adjacent pelvic or abdominal structures. One of the less frequent but clinically relevant complications is intravesical migration, where the device perforates the uterine wall and erodes into the urinary bladder. This can result in chronic lower urinary tract symptoms, recurrent urinary tract infections, hematuria, pelvic discomfort, and, in some cases, stone formation around the foreign body. We present the case of a 26-year-old female patient who developed recurrent urinary symptoms and intermittent hematuria three years after IUD placement. The device had not been visualized during gynecological follow-up and remained undetected during two full-term pregnancies. A noncontrast abdominal CT scan ultimately revealed a calcified IUD located within the urinary bladder. The patient underwent successful transurethral endoscopic removal using holmium:YAG laser lithotripsy in dusting mode to fragment the calcifications, followed by retrieval of the intact device with foreign body forceps. The procedure was completed without complications, and the patient reported full resolution of symptoms during follow-up. This case underscores the importance of considering IUD migration as a differential diagnosis in women presenting with unexplained urinary symptoms and a remote history of IUD use. It also demonstrates that holmium laser-assisted endoscopic management provides a safe, effective, and minimally invasive approach to remove encrusted or calcified intravesical IUDs, avoiding the need for open or laparoscopic surgery.