Bladder Stone Forming on Migrated Surgical Clip Ten Years after Robotic-Assisted Radical Prostatectomy: A Case Report and Literature Review
Yi-Hsuan Chen, Wei-Kung Tsai
Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
In robotic-assisted radical prostatectomy (RARP), surgical clips are usually used to control lateral pedicles of the prostate and hemostasis. However, complications related to the clips have been reported, of which intravesical migration is the most common. The incidence of intravesical clip migration is estimated to be around 0.57% to 1%. Intravesical stone formation on the migrated clip has been reported only few times in the literature and here we present a case where a bladder stone was discovered on the migrated clip ten years after RARP.
A 65-year-old male with history of localized prostate cancer and underwent RARP in the United States about 10 years ago. He complained of progressing urinary frequency, urgency, and nocturia in recent 5 years. Blood test were generally within normal limits and PSA remained undetectable. Urinalysis showed no hematuria or pyuria. Uroflowmetry revealed satisfactory maximal flow rate and residual urine, but a 1.5 cm hyperechoic lesion was noted at bladder neck.
Cystoscopy was performed and revealed a stone at bladder neck. The stone was growing on a metallic clip adhesive to anastomotic site of RARP. The calculus was fragmented using a pneumatic lithotripsy introduced in a resectoscope sheath and the surgical clip was removed with forceps.
The majority of bladder stones encountered in the adult population are secondary to lower urinary tract obstruction. Cases of foreign material acting as a nidus for stone formation were also reported. Most intravesical foreign bodies result from iatrogenic intervention such as minimally invasive intraabdominal surgery. Although extremely rare, surgical clips used during radical prostatectomy can migrate and serve as a nidus of bladder stone formation. Surgeons should be cautious of this complication as the timing and the clinical presentations vary widely.