Distal ureteral stone formation over migrated Hem-o-lok clip after robot-assisted partial nephrectomy. (2019)

• Record Type: Journal Article
• Authors: Kiremit, Murat Can; Koseoglu, Ersin; Acar, Omer; Kilic, Mert; Kordan, Yakup; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Esen, Tarık
• Is Part Of: International journal of surgery case reports. Volume 58(2019)
• Page Start: 201
• Page End: 204
• Publication Date: 2019
• Subjects: Clips -- Minimally invasive surgery -- Urinary lithiasis -- Case reports; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.03.024
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Foreign bodies, such as suture materials, mesh, cotton swab, Hem-o-lok clips, metallic clips, coils used for angioembolization etc. are rare causes of urinary tract stone disease. Clinicians should be aware of the possibility of migrated hem-o-lok clips serving as a nidus for urinary tract stone formation in patients who have undergone endoscopic PN. Attention to suture tension during endoscopic partial nephrectomy may reduce the risk of clip migration. Laser lithotripsy of the calculous cortical rim around the Hem-o-lok clip(s) and removal of the denuded foreign body under direct endoscopic visualization are strongly advisable, since Hem-o-lok clips are usually SWL-resistant. Abstract: Introduction: Hem-o-lok clip migration into the ipsilateral collecting system and formation of a distal ureteral stone after robot-assited partial nephrectomy (PN) is a rare condition of stone disease. Presentation of case: A 48-year-old male presented with hematuria. Physical examination was unremarkable. Urinalysis showed presence of red blood cells. Serum multiple analysis and ultrasonography were within normal limits. Contrast enhanced abdominal computerized tomography scan revealed an 8-mm right distal ureteral stone, which was not associated with ipsilateral hydronephrosis. Discussion: With the widespread adoption of minimally invasive surgery, it is not uncommon to utilize foreign bodies as surgical facilitators which also have the potential to migrate to the urothelium-lined urinary tract and act as a stone nidus when used for endoscopic PN Conclusion: Clinicians should be aware of the possibility of migrated hem-o-lok clips serving as a nidus for urinary tract stone formation in patients who have undergone endoscopic PN.