Korean J Urol.  2010 Oct;51(10):683-687.

Surgical Clip-Related Complications after Radical Prostatectomy

• Yi JS
• Kwak C
• Kim HH
• Ku JH

Abstract

PURPOSE
The aim of this study was to describe the surgical clip-related complications that can occur after open retropubic prostatectomy (RRP), pure laparoscopic prostatectomy (LRP), and robot-assisted laparoscopic radical prostatectomy (RALP).
MATERIALS AND METHODS
A database of 641 patients who underwent RRP (n=439), LRP (n=49), and RALP (n=153) at our institution between January 2006 and April 2009 was reviewed to identify patients with complications related to the use of surgical clips. The median follow-up time for the entire cohort was 19.0 months (range, 1-42 months).
RESULTS
Of the 641 patients, 25 (5.7%), 1 (2.0%), and 2 (1.3%) had a bladder neck contracture after RRP, LRP, and RALP, respectively. Two RRP patients had a bladder stone. In total, 6 patients had surgical clip-related complications. Metal clip migration was associated with 2 (8%) of the 25 RRP cases of bladder neck contracture and both (100%) of the RRP cases of bladder stone. Moreover, both (100%) of the RALP cases of bladder neck contractures were associated with Hem-o-lok clip migration into the anastomotic site.
CONCLUSIONS
Surgical clips are prone to migration and may cause, or significantly contribute to, bladder neck contracture or the formation of bladder stones after radical prostatectomy. These findings also suggest that because the incidence of bladder neck contracture after RALP is low, the migration of Hem-o-lok clips should be suspected when voiding difficulty occurs after RALP.

Keyword

Prostatectomy; Prostatic neoplasms; Surgical instruments; Urinary bladder calculi; Urinary bladder neck obstruction

MeSH Terms

Cohort Studies
Contracture
Follow-Up Studies
Humans
Incidence
Neck
Prostatectomy
Prostatic Neoplasms
Surgical Instruments
Urinary Bladder
Urinary Bladder Calculi
Urinary Bladder Neck Obstruction

Figure

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  FIG. 1 (A) Lateral view of cystography: a surgical metal clip can be seen in contact with the urethra (arrow). (B) Cystoscopic evidence of clip-induced erosion.

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  FIG. 2 Cystoscopy showing a Hem-o-lok clip at the vesicourethral anastomosis.

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  FIG. 3 Cystoscopic view of a bladder stone that formed around a metal clip.

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  FIG. 4 KUB showing a surgical clip within the radio-opaque density in the pelvis (arrow).

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