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

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.

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.

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.