The use of synthetic meshes in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse has been a cornerstone of urogynecology; however, mesh-related complications such as erosion remain a clinical challenge. We present the case of a 44-year-old female with a complex surgical history, including an initial SUI surgery in 2016, followed by posterior intravaginal sling (IVS) and tension-free vaginal tape (TVT) procedures in 2022. Despite a partial vaginal mesh excision in early 2024, the patient continued to suffer from persistent dyspareunia and dysuria. This video demonstrates a laser-assisted approach for the excision of calcified urethral mesh erosion.

A comprehensive diagnostic and therapeutic strategy was implemented: Clinical Findings: Gynecological examination revealed a Grade 1-2 cystocele, with no significant rectocele or caruncle. Cystoscopic Evaluation: Flexible cystoscopy performed in August 2025 identified calcified (encrusted) surgical material secondary to previous repairs, located specifically at the urethral meatus and entrance. Surgical Objective: The primary goal was the complete removal of the lithogenic (stone-forming) mesh fibers and encrusted material that were causing chronic urethral irritation and pain. Technique: A laser-assisted excision was chosen to precisely fragment the calcifications and release the embedded mesh fibers from the urethral mucosa with minimal thermal damage to the surrounding healthy tissue.

The laser-assisted procedure allowed for high-precision removal of the encrusted material. Surgical Outcome: The calcified mesh fibers were successfully identified and excised. The laser effectively cleared the encrustations that were otherwise difficult to manage with cold-cut instruments. Patient Recovery: Postoperatively, the patient reported an immediate and significant reduction in dysuria. Follow-up: At the subsequent evaluations, the urethral mucosa showed healthy healing. The patient confirmed the resolution of dyspareunia, marking a major improvement in her quality of life and functional outcomes.

Urethral mesh erosion, especially when complicated by calcification, requires a specialized surgical approach. While traditional excision methods are standard, a laser-assisted technique provides superior precision in managing encrusted surgical materials within the delicate urethral anatomy. This case emphasizes that laser technology can simplify the management of "stone-coated" meshes, ensuring complete removal and preventing recurrent irritation, thereby offering a highly effective salvage option for patients with chronic mesh complications.

Chapple, C. R., et al. (2020). "Management of Mesh Complications in Urogynecology: Guidelines from the International Urogynecological Association (IUGA) and International Continence Society (ICS)." Neurourology and Urodynamics.
Crosby, E. C., et al. (2015). "Erosion of Midurethral Slings Into the Lower Urinary Tract: Management and Outcomes." Female Pelvic Medicine & Reconstructive Surgery.
Tienza, A., et al. (2014). "Laser treatment for mesh-related complications after anti-incontinence surgery." Journal of Endourology.