Intravesical Hemostatic Clip Migration After Robotic Prostatectomy: Case Series and Review of the Literature

A seed link connector protruding into the bladder formed a bladder stone

Introduction

Low-dose-rate brachytherapy is performed for localized prostate cancer. We report the first case of a bladder stone encompassing the seed migrated into the bladder in a patient treated with low-dose-rate brachytherapy.

Case presentation

A man was diagnosed with prostate cancer and underwent low-dose-rate brachytherapy. After 2 months, dysuria occurred, and ultrasonography revealed a needle-shaped high-intensity protruding from the prostate into the bladder. Cystoscopy examination found a seed link connector. With the possibility of natural dissolution of the seed link, careful observation was chosen. However, 16 months later, hematuria occurred, and an X-ray revealed a bladder stone encompassing the seed. Compared with the X-ray right after seeding, the seed located near the right bladder neck had fallen. The seed was removed by transurethral bladder lithotripsy.

Conclusion

Seeds should be carefully located within the prostate, otherwise a bladder stone may be formed encompassing the seed.

Hemoclip migration after revision carpal tunnel release: a case report

A 22-year-old female presented to our clinic with the redevelopment of compressive symptoms after undergoing right carpal tunnel release 2 years prior. During revision surgery, the application of a chitosan polysaccharide membrane wrap over the median nerve was secured with three hemoclips. Follow-up revealed that these clips traveled distally to the volar aspect of the patient's small finger necessitating excision. Hemoclips in hand surgery serve as a useful tool for securing constructs; however, the recommendation to use them sparingly is made because of the potential for migration and exacerbation of symptoms.

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.

Type II Hem-o-lok clip migration and stone formation in robot assisted laparoscopic prostatectomy patient: A case report and serial cases review

Hem-o-lok clips (HOLC) migration after laparoscopic surgery may cause delayed postoperative issues. We present a delayed lower urinary tract symptoms (LUTS) and urinary stones due to HOLC migration from previous radical prostatectomy approximately 10 years ago. A 88-year-old man presenting clinic with LUTS; previously received robotic-assisted laparoscopic radical prostatectomy (RALP) 10 years ago. HOLC and stones from the bladder were extracted with cystoscopy lithotripsy. Latest follow-up noted complete resolution of symptoms. RALP may cause HOLC migration with variable duration of LUTS symptoms occurring, reaching up to 10 years.

Absolok® versus Hem-o-Lok® clips for renorrhaphy during partial nephrectomy for parenchymal renal tumors

BACKGROUND

To compare perioperative and functional outcomes associated with renorrhaphy performed with two different types of clips (Absolok® vs. Hem-o-Lok®) in a contemporary series of patients who underwent partial nephrectomy.

METHODS

Patients in whom Absolok® clips were used to perform haemostasis at the level of tumor bed or to block the running sutures during sliding-clip renorrhaphy (study group) were compared with a contemporary control group of patients in whom renorrhaphy was performed with Hem-o-Lok® clips. Both groups received the same surgical technique via an open or robot-assisted approach. Inner renorrhaphy was performed with one or more 3-0 (26 mm needle) monofilament running suture(s) preloaded with medium Absolok® clips in the study group, and with medium Hem-o-Lok® clips in the control group. Cortical renorrhaphy was performed using interrupted 2-0 (26 mm needle) polyfilament sutures placed at intervals of 1 cm using the sliding-clip technique with Absolok® clips in the study group and with Hem-o-Lok® clips in the control group. Intraoperative and postoperative outcomes were compared.

RESULTS

Absolok® clips were used in 57 patients, while Hem-o-Lok® clips were used in 40 patients. The two groups were comparable for all preoperative patient and tumor characteristics. No differences were observed in terms of operating room time (P=0.29), off-clamp technique rate (P=0.96), warm ischemia time (P=0.19) and estimated blood loss (P=0.18). No difference in the rate of positive surgical margins was detected (P=0.21). Ninety-day complications were observed in 32 (33%) cases. No difference in overall and major postoperative complications were observed between the two groups (P=0.20). Abdominal CT scan performed after 3 months following surgery showed no Absolok® clips in all cases.

CONCLUSIONS

Absolok® clips are a valid alternative to Hem-o-Lok® clips to secure blood vessels at the level of tumor bed and to perform a sliding-clip renorrhaphy in patients who underwent open or robot-assisted partial nephrectomy.

Distal ureteral stone formation over migrated Hem-o-lok clip after robot-assisted partial nephrectomy

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Foreign bodies, such as suture materials, mesh, cotton swab, Hem-o-lok clips, metallic clips, coils used for angioembolization etc. are rare causes of urinary tract stone disease.

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Clinicians should be aware of the possibility of migrated hem-o-lok clips serving as a nidus for urinary tract stone formation in patients who have undergone endoscopic PN.

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Attention to suture tension during endoscopic partial nephrectomy may reduce the risk of clip migration.

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Laser lithotripsy of the calculous cortical rim around the Hem-o-lok clip(s) and removal of the denuded foreign body under direct endoscopic visualization are strongly advisable, since Hem-o-lok clips are usually SWL-resistant.

Introduction

Hem-o-lok clip migration into the ipsilateral collecting system and formation of a distal ureteral stone after robot-assited partial nephrectomy (PN) is a rare condition of stone disease.

Presentation of case

A 48-year-old male presented with hematuria. Physical examination was unremarkable. Urinalysis showed presence of red blood cells. Serum multiple analysis and ultrasonography were within normal limits. Contrast enhanced abdominal computerized tomography scan revealed an 8-mm right distal ureteral stone, which was not associated with ipsilateral hydronephrosis.

Discussion

With the widespread adoption of minimally invasive surgery, it is not uncommon to utilize foreign bodies as surgical facilitators which also have the potential to migrate to the urothelium-lined urinary tract and act as a stone nidus when used for endoscopic PN

Conclusion

Clinicians should be aware of the possibility of migrated hem-o-lok clips serving as a nidus for urinary tract stone formation in patients who have undergone endoscopic PN.