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

Abstract

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

Urolithiasis secondary to Hem-o-lok partial migration into renal calyx as a long-term complication of robotic partial nephrectomy: a case report and literature review

“…However, this case has some several peculiarities: rst of all, the vast majority of the urinary stones secondary to HOLC have been described as ureteral calculi [9,10]. In this case the stone was instead located into a renal calyx.…”

“…In renal surgery they have become a cornerstone in the surgical technique, especially for partial nephrectomies (PN) [1]. However, in literature are reported several cases of HOLC migration into the collecting system where they could act as a nidus for stone [2]. Here we describe a case of a late-onset urolithiasis secondary to HOLC migration into the urinary tract after a robotic partial nephrectomy.…”

Hem-o-Lok clip migration into renal pelvis and stone formation as a long-term complication following laparoscopic pyelolithotomy: a case report and literature review

“…If foreign bodies, like metallic coils, surgical staples, titanium and Hem-o-Lok clips, enter the collecting system, they can serve as a nidus for stone formation under extended exposure to urine [ 3 ]. With the wide use of HOLCs in laparoscopic operations, relevant complications step into the vision of urologists.…”

“…However, this particular clinical setting always occurred in the vicinity of anastomosis. One of the possible causes is the excessive suture tension, which makes a chronic continuing erosion of HOLCs [ 2 , 3 ]. Another reason may be attributed to delayed healing due to chronic kidney disease and diabetes [ 4 ].…”

A Cumbersome Rolling Stone

“…The stone was about 1 cm in length and appeared to incorporate a surgical staple inside, likely dating back to the patient's cystectomy intervention (Figure 2). Foreign bodies, such as clips, staples, suture materials, and mesh, are calculogenic in the urinary tract, 3 and the duration of contact between foreign bodies and urine is a predictor of calculus formation because the presence of urine plays a pivotal role in stone building. 4 Previously, Bayles et al 5 described calcified ureteral Hem-o-lok clips (Teleflex, Athlone, Ireland) in the pelvic ureter.…”