[INTRAVESICAL MIGRATION OF A HEM-O-LOK CLIP AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: A CASE REPORT]

Stone Formation Due to Migration of Hemostatic Clip After Robot-Assisted Laparoscopic Radical Prostatectomy: A Late and Rare Presentation

A very rare complication of robot-assisted laparoscopic radical prostatectomy (RALP) is bladder stone formation from a hemostatic clip as a nidus. A 70-year-old man presented 11 years after a RALP with recurrent UTI, worsening lower urinary tract symptoms, and visible haematuria. A flexible cystoscopy revealed a large 3.5 cm x 1.5 cm stone at the bladder neck. Computed Tomography (CT) Urogram revealed normal kidneys with no hydronephrosis and a bladder stone. The patient underwent a cystolithotripsy as a day case which was performed by use of Swiss LithoClast® Trilogy lithotripter, which delivered controlled ultrasonic and ballistic energy and simultaneous suction through a single probe. Hemostatic clips were incidentally identified during the procedure and were successfully removed. The patient was discharged on the same day and made an excellent recovery. Hence, migration of clips is a rare occurrence, and good intraoperative techniques should avoid such complications to occur.

Late-onset Hem-o-Lok® migration into the bladder after robot-assisted radical prostatectomy

INTRODUCTION

Hem-o-Lok® clips are widely used in robot-assisted radical prostatectomy because of their ease of application and secure clamping. Although there have been some reports of their migration into the urinary tract, this usually occurs a few months after robot-assisted radical prostatectomy. Late-onset cases of Hem-o-Lok® clip migration, that is, after more than 1 year, are rare.

CASE PRESENTATIONS

We report three cases of delayed endourethral Hem-o-Lok® clip migration more than 2 years after robot-assisted radical prostatectomy. The Hem-o-Lok® clips were almost completely endoluminal, and were attached at one end to the vesicourethral anastomosis. We successfully removed them via transurethral surgery using a holmium laser.

CONCLUSION

This case series describes late-onset Hem-o-Lok® clip migration into the bladder more than 1 year after robot-assisted radical prostatectomy. Transurethral holmium laser surgery was very effective for Hem-o-Lok® clip removal. To avoid involvement of Hem-o-Lok® clips in the vesicourethral anastomosis, appropriate resection at the time of bladder neck transection is important.