Incidental detection of asymptomatic migration of Hem‐o‐lok clip into the bladder after laparoscopic radical prostatectomy

Iizuka, Junpei; Hashimoto, Yuichi; Kondo, Tsunenori; Takagi, Toshio; Hata, Keisuke; Kanzawa, Taichi; Tachibana, Hidekazu; Yoshida, Kazuhiko; Tanabe, Kazunari

doi:10.1111/ases.12384

Cited by 7 publications

(12 citation statements)

References 9 publications

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“…In cases where HOLC migration occurred soon after surgery, the site of migration was often the vesicourethral anastomosis. 17 In cases where HOLC migration occurred more than 1 year after RARP, often into the bladder, the reason for migration may have been different. Kadekawa et al 18 suggested that inflammation around the bladder and/or vesicourethral anastomosis could have been the main factor, but this remains to be confirmed.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…2,9 There have been concerns that metallic and Hem-o-Lok ® clips are prone to migration into the bladder while further causing BNC after laparoscopic (LRP) or robot-assisted laparoscopic radical prostatectomy (RALP). 2,11,12 The exact incidence of intravesical clip migration is still unknown, and the underlying mechanism of intravesical clip migration is a riddle to be solved. 4,11 Various hypotheses imply different paths ranging from inflammation around the bladder and/or VUR, to clip-induced inflammation and bladder wall erosion with consequent intravesical SC migration.…”

Section: Discussionmentioning

confidence: 99%

“…4,11 Various hypotheses imply different paths ranging from inflammation around the bladder and/or VUR, to clip-induced inflammation and bladder wall erosion with consequent intravesical SC migration. 9,12,13 Furthermore, postoperative pelvic radiotherapy for prostate cancer might play a substantial role in contributing to poor healing of the VUR anastomosis. 4,11,12 Yu et al 11 have notably proposed a classification of three distinct types of intravesical HOLC migration after LRP or RLP based on the clinical severity.…”

Section: Discussionmentioning

confidence: 99%

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Incidental discovery of endourethral clip migration 10 years after radical prostatectomy: A case report and review of the literature

et al. 2021

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Introduction: Surgical clips (SCs) have been widely used for a variety of surgical procedures over the years. Despite their advantages and proven effectiveness, several clip-related complications have been reported, creating dilemmas as to their optimal use. Case description: Herein, we present a rare delayed and incidental discovery of two endourethral metallic SCs in a 77-year-old male seeking treatment for acute renal colic. The patient had undergone open radical retropubic prostatectomy 10 years ago, and had an uneventful postoperative recovery. Computed tomography scan revealed left-sided hydronephrosis secondary to proximal ureteral calculus, as well as SCs at the level of vesico-urethral (VUR) anastomosis. Flexible cystoscopy confirmed the imaging findings, showing two endourethral clips, partly obstructing the VUR. Firstly, a serial wire-guided dilation took place, followed by left ureteral double-J stent placement. Unfortunately, the clips could not be concurrently removed due to their firm attachment to the bladder neck. Hence, our patient was scheduled for transurethral resection of the bladder neck and simultaneous endoscopic clip removal. Conclusions: To the best of our knowledge, this is the first report to highlight such a delayed incidental finding, 10 years after open retropubic radical prostatectomy (RRP), during a JJ stent insertion for obstructive uropathy without previous clip-induced lower urinary tract symptoms. Although rare, physicians should be aware of the potential clip-related complications arising either in the short- or long-term postprostatectomy setting.

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“…Erosion of different type of clips (metal clip, absorbable Lapra-Ty suture clip, Hem-o-lok clip) into the renal collecting system has been documented in the literature [13,14]. Spontaneous discharge of titanium metal clips and Lapra-Ty suture clips without stone formation have been reported [3,[15], [16], [17]]. Park et al presented a case of ureteral migration of a Hem-o-lok clip after laparoscopic PN and highlighted its successful management with ureteroscopic basket extraction [14].…”

Section: Discussionmentioning

confidence: 99%

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

Kiremit

Köseoğlu

Acar

et al. 2019

International Journal of Surgery Case Reports

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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.

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Incidental detection of asymptomatic migration of Hem‐o‐lok clip into the bladder after laparoscopic radical prostatectomy

Cited by 7 publications

References 9 publications

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

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

Incidental discovery of endourethral clip migration 10 years after radical prostatectomy: A case report and review of the literature

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

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