異位的Hem-o-Lok在腹腔鏡前列腺根除手術12年後以膀胱結石呈現

張家郡、葉進仲

中國醫藥大學附設醫院泌尿部

Hem-o-Lok Clip Migration Presenting as a Bladder Stone 12 years After Laparoscopic Radical Prostatectomy

Jia- Jyun Jhang, Ching-Chung Yeh 

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction: Hem-o-Lok clips, a Non absorbable hemostatic Clip, are commonly utilized in various laparoscopic surgical fields. Migration of these surgical clips are rare, and have been reported in different operations resulting from asymptomatic incidental finding to disastrous complications. In this report, we present a unique case in which a bladder stone was discovered to be the result of Hem-o-Lok clip migration, occurring 12 years after a laparoscopic radical prostatectomy.

Case presentation: This 83 years old male was diagnosed as Prostate adenocarcinoma during 2011, he subsequently underwent laparoscopic radical prostatectomy. Following the operation, the patient's condition remained stable, without experiencing any issues related to urinary incontinence or voiding difficulties. However, in 2023, the patient reported right lower abdominal pain, along with frequency, hematuria and dysuria. IVP was conducted, revealing the presence of a suspected vesicle stone. Subsequently, cystolithotripsy was arranged for the patient, during which a bladder stone was identified. Remarkably, it was discovered that a Hem-o-Lok clip is the nidus of the stone. The clip was safely removed, and the patient was able to void without any difficulties once the Foley catheter was removed on the following day after the operation.

Conclusion: In cases where Hem-o-Lok clips migrate after laparoscopic radical prostatectomy, various scenarios can unfold. These clips may either pass spontaneously, remain undetected within the bladder, evolve into bladder stones, or potentially result in bladder neck contracture. This migration can manifest from days to years after the initial surgery and, if not promptly identified, may lead to a range of complications. As such, it is crucial to always consider the possibility of migrated Hem-o-Lok clips following laparoscopic or robotic-assisted radical prostatectomy in order to prevent potentially devastating consequences.