Intrauterine contraceptive devices (IUCDs) are a key long-acting contraception method, but rare migration into the bladder can trigger vesical calculus formation and persistent lower urinary tract symptoms (LUTS). This case report highlights the endoscopic management of an encrusted Copper-T IUCD within a large bladder stone, showcasing advanced endourological techniques.

A 42-year-old woman with a 6-month history of LUTS (suprapubic pain, dysuria, frequency, nocturia, straining) and no known IUCD use underwent evaluation after failed antimicrobial therapy for presumed cystitis. NCCT KUB revealed a 40 × 15.6 mm vesical calculus with an embedded IUCD. She underwent percutaneous ultrasonic cystolithotripsy (PUCLT) and Holmium:YAG laser lithotripsy (1.5 J, 10 Hz, 15 W) under spinal anesthesia using a 22Fr cystoscope, followed by IUCD extraction.

The procedure achieved complete stone and IUCD removal, with no complications. LUTS resolved, and spontaneous voiding resumed by postoperative day 1, demonstrating the success of minimally invasive endourology.

This case emphasizes suspecting IUCD migration in unexplained LUTS, even without a known history, as silent translocation can lead to stone formation. Holmium:YAG laser lithotripsy offers an effective, minimally invasive solution. Enhanced follow-up, patient education, and IUCD tracking innovations are critical to reduce such complications.