手術夾轉移至膀胱內：一個罕見且延遲的達文西攝護腺根除手術之併發症
陳浩瑋1, 2、陳妤甄1, 2、李政學1, 2、黃書彬1, 2
高雄醫學大學臨床醫學研究所1；高雄醫學大學附設醫院泌尿部2
Intravesical migration of a Hem-o-lok clip: A rare delayed complication five years after robotic assisted radical prostatectomy
Hao-Wei Chen1,2, Yu-Chen Chen1,2, Cheng-Hsueh Lee1,2, Shu-Pin Huang1,2
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan1
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan2
A 75-year-old man was diagnosed with prostate adenocarcinoma and underwent robotic-assisted radical prostatectomy (RARP) five years earlier. Tracking back to the RARP, V-Loc™ (Covidien, Dublin, Ireland) with Hem-o-lok® clip (Weck, Durham, NC) fixation was used for direct urethra-bladder neck anastomosis. The postoperative cystography showed no extravasation of the contrast. Recently, he complained of new-onset intermittent gross hematuria for several days. Surveillance imaging revealed a bladder stone. Following laser fragmentation of the stone, the Hem-o-lok® clip was identified. The patient was then successfully treated with transurethral resection of fibrotic tissue that adhered to the Hem-o-lok® clip.
Intravesical migration of a Hem-o-lok® clip, from the previous RARP, formed the foreign body in the bladder, and presented as lower urinary tract symptoms after the early postoperative period. We presented the case of a rare symptomatic bladder stone that occurred five years after RARP. The slow migration and erosion of the clip probably caused the late formation of the bladder stone. Importantly, we should keep this situation in mind, even years after surgery. We suggest typing the knob of V-Loc™, instead of using Hem-o-lok® clip fixation, for anastomosis of the urethra-bladder neck in RARP.