Delayed Hem-o-Lok Clip Erosion Following Salvage Radical Prostatectomy
Philip G. Wong, PhD, Samay Jain, MD
University of Toledo College of Medicine, Toledo, OH, USA (all authors). Department of Urology, University of Toledo Medical Center, Toledo, OH, USA (Dr. Jain).
Introduction: Weck Hem-o-Lok (Teleflex Medical, Research Triangle Park, North Carolina) clips are frequently used to achieve hemostasis of the lateral prostatic pedicles during radical prostatectomy. Rarely, these clips can detach and migrate into the bladder wall, leading to postoperative urinary tract complications. Hem-o-Lok clip migration into the bladder is a rare complication of laparoscopic radical prostatectomy that has been reported within 1 year postsurgery.
Case Report: We report the case of a 61-year-old white man who presented with urinary stress incontinence, acute urinary retention, and a history of recurrent urinary tract infections more than 2 years after salvage robot-assisted laparoscopic radical prostatectomy for recurrent prostate cancer that was unsuccessfully treated with brachytherapy. As part of his diagnostic workup, cystoscopy demonstrated an open bladder neck with no evidence of contracture and the presence of a calcification near the vesicourethral anastomosis. Unroofing these calcifications via laser lithotripsy revealed two eroded Hem-o-Lok clips, which were subsequently removed from the bladder wall.
Conclusion: Salvage prostatectomy after radiotherapy as the primary treatment for prostate cancer may increase the window of time in which intravesical clip migration can occur because of delayed wound healing at the vesicourethral anastomosis. Furthermore, clip migration can present with signs of urinary tract dysfunction in the absence of bladder neck contracture and beyond the time frame initially expected.
Key Words: Prostatic neoplasms, Prostatectomy, Laparoscopy, Urinary incontinence, Postoperative complications.