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Surgical clip-related complications after radical prostatectomy.

Yi JS, Kwak C, Kim HH, Ku JH - Korean J Urol (2010)

Bottom Line: The median follow-up time for the entire cohort was 19.0 months (range, 1-42 months).In total, 6 patients had surgical clip-related complications.Moreover, both (100%) of the RALP cases of bladder neck contractures were associated with Hem-o-lok clip migration into the anastomotic site.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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

Mentions: The characteristics of these 6 patients are summarized in Table 1. All 6 patients had obstructive lower urinary tract symptoms after surgery. Cystoscopic examination of patient 1 revealed a metal clip within the BNC scar tissue. Urethral dilatation and transurethral incision were performed, but the symptoms recurred rapidly. This patient currently requires serial intermittent urethral dilatations. Cystoscopic examination of patient 2 indicated BNC and the presence of a metal clip protruding into the urethra through the urethrovesical anastomosis at 4 o'clock (Fig. 1). This patient responded to dilatation. Patients 3 and 4 were both found to have a Hem-o-lok clip in the bladder neck (Fig. 2). Their BNCs were resolved after a single urethral dilatation, after which the symptoms disappeared. Patients 5 and 6 were found to have a bladder stone that had formed around the metal clip in the bladder (Fig. 3). Transurethral holmium laser lithotripsy was performed. Retrospective re-evaluation of the kidney, ureter and bladder X-ray (KUB) revealed the metal clip in the bladder region (patient 5: Fig. 4). During the follow-up, neither patient exhibited signs of bladder stone recurrence. In all patients, the offending surgical clip was easily removed by using a grasping forceps.


Surgical clip-related complications after radical prostatectomy.

Yi JS, Kwak C, Kim HH, Ku JH - Korean J Urol (2010)

KUB showing a surgical clip within the radio-opaque density in the pelvis (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2963780&req=5

Figure 4: KUB showing a surgical clip within the radio-opaque density in the pelvis (arrow).
Mentions: The characteristics of these 6 patients are summarized in Table 1. All 6 patients had obstructive lower urinary tract symptoms after surgery. Cystoscopic examination of patient 1 revealed a metal clip within the BNC scar tissue. Urethral dilatation and transurethral incision were performed, but the symptoms recurred rapidly. This patient currently requires serial intermittent urethral dilatations. Cystoscopic examination of patient 2 indicated BNC and the presence of a metal clip protruding into the urethra through the urethrovesical anastomosis at 4 o'clock (Fig. 1). This patient responded to dilatation. Patients 3 and 4 were both found to have a Hem-o-lok clip in the bladder neck (Fig. 2). Their BNCs were resolved after a single urethral dilatation, after which the symptoms disappeared. Patients 5 and 6 were found to have a bladder stone that had formed around the metal clip in the bladder (Fig. 3). Transurethral holmium laser lithotripsy was performed. Retrospective re-evaluation of the kidney, ureter and bladder X-ray (KUB) revealed the metal clip in the bladder region (patient 5: Fig. 4). During the follow-up, neither patient exhibited signs of bladder stone recurrence. In all patients, the offending surgical clip was easily removed by using a grasping forceps.

Bottom Line: The median follow-up time for the entire cohort was 19.0 months (range, 1-42 months).In total, 6 patients had surgical clip-related complications.Moreover, both (100%) of the RALP cases of bladder neck contractures were associated with Hem-o-lok clip migration into the anastomotic site.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus