Intravesical tape erosion with calculus growth can complicate transobturator tape procedures. The treatment of such erosions is traditionally reported through the transurethral route using laser or electrocautery to cut the foreign material. Such methods have a high rate of incomplete material removal and as a result a high recurrence rate. Disadvantages of standard methods, either open, laparoscopic, or robotic, include relatively high morbidity, a long hospital stay, and unsatisfactory cost-effectiveness. As such, we will later describe an innovative alternative that we use to surgically treat these clinical cases.

A 73-year-old woman was admitted for recurrent urinary tract infections, 14 years after a transobturator tape procedure for the treatment of genital prolapse. Pelvic sonography, followed by cystourethroscopy, demonstrated an eroded tape inside the bladder with heavy calculus growth.
The calculus was fragmented by using Holmiun laser cystolithotripsy. The tape was excised and removed through mesh fixation and traction with forceps placed transurethrally parallel to the endoscope while cutting the mesh close to the vesical mucosa with scissors, introduced through the cystoscope. Finally, the mesh remnants were vaporized with the LASER (Auriga XL 50-watt Holmium LASER – 600μm fiber - setting coagulation 1200mJ/12Hz) up to the vesical serosa, to facilitate the bladder healing. The patient remained catheterized for 12 days and medicated with potassium citrate for six months.

The foreign material was removed entirely, with no traces of an intravesical mesh in the cystoscopy performed six months after the procedure. The patient remains asymptomatic from the genitourinary point of view, with no recurrence at a follow-up of 8 months.

Intravesical tape erosion with calculus growth is amenable to transurethral laser cystolithotripsy and cystoscopic excision. We want to emphasize the need to pull the mesh into the bladder to be able to completely cut it from its wall with scissors, as well as the LASER settings for the final vaporization of the mucosa defect to free the mesh remnants.