Hem-o-Lok® clip migration after robotic prostatectomy: PRISMA-guided review with two illustrative cases

Hem-o-Lok® polymer clips are widely used during robot-assisted radical prostatectomy. Although generally safe, delayed intravesical migration is an under-recognized source of lower urinary tract symptoms, haematuria and bladder stone formation. We report two illustrative cases - one with large bladder calculus formed around an eroded clip and another with spontaneous urethral passage - then synthesize the contemporary literature using a PRISMA-guided search. Across > 100 reported patients, time to presentation ranges from 1 to 252 months. The commonest presentations are LUTS, haematuria and recurrent infection; most cases are diagnosed by cystoscopy (often with confirmatory CT) and managed endoscopically with clip extraction ± laser lithotripsy, with open removal reserved for inaccessible or embedded clips. Proposed mechanisms include clip placement close to the vesicourethral anastomosis, devitalized tissue at the anastomosis, urine leak and radiotherapy-related impaired healing. Preventive strategies center on minimizing clip use near the anastomosis, meticulous retrieval of loose clips, judicious energy use at the apex/bladder neck, and considering alternatives (suture ligation or vessel-sealing devices) where appropriate. Increased awareness can shorten time to diagnosis and reduce morbidity for post-prostatectomy patients presenting with non-specific urinary symptoms years after surgery.