Stone Formation Due to Migration of Hemostatic Clip After Robot-Assisted Laparoscopic Radical Prostatectomy: A Late and Rare Presentation

Abstract

A very rare complication of robot-assisted laparoscopic radical prostatectomy (RALP) is bladder stone formation from a hemostatic clip as a nidus. A 70-year-old man presented 11 years after a RALP with recurrent UTI, worsening lower urinary tract symptoms, and visible haematuria. A flexible cystoscopy revealed a large 3.5 cm x 1.5 cm stone at the bladder neck. Computed Tomography (CT) Urogram revealed normal kidneys with no hydronephrosis and a bladder stone. The patient underwent a cystolithotripsy as a day case which was performed by use of Swiss LithoClast® Trilogy lithotripter, which delivered controlled ultrasonic and ballistic energy and simultaneous suction through a single probe. Hemostatic clips were incidentally identified during the procedure and were successfully removed. The patient was discharged on the same day and made an excellent recovery. Hence, migration of clips is a rare occurrence, and good intraoperative techniques should avoid such complications to occur.