Bladder Stone Formation on Migrated Hem-o-Lok Clips at the Vesicourethral Anastomosis After Robot-Assisted Radical...

Robot-assisted radical prostatectomy (RARP) is a well-established surgical treatment for localized prostate cancer, offering excellent oncologic outcomes with reduced perioperative morbidity compared to open surgery. Hem-o-Lok® clips are routinely used during RARP to achieve hemostasis and facilitate precise dissection of the prostatic pedicles. Although generally safe, migration of these non-absorbable clips to the vesicourethral anastomosis represents an uncommon but clinically relevant late complication. Once exposed to urine, migrated clips may serve as a nidus for encrustation and subsequent stone formation, resulting in hematuria or lower urinary tract symptoms (LUTS) that may manifest months or even years after surgery. We present a rare case of bladder stone formation on migrated Hem-o-Lok® clips at the vesicourethral anastomosis four years following RARP, highlighting its clinical presentation, diagnostic workup, endoscopic management, and an alternative mechanical technique for complete clip removal aimed at minimizing the risk of anastomotic injury and recurrence.