Bladder neck contractures related to the use of Hem-o-lok clips in robot-assisted laparoscopic radical prostatectomy.
OBJECTIVE
Recently, several large series of robot-assisted laparoscopic radical prostatectomy (RALP) have described a low incidence of bladder neck contractures (BNC). We have had a similar experience at our institution. Our objective is to describe our experience with BNC after RALP and a novel relationship to the use of Hem-o-lok Clips (HOLC).


METHODS
We reviewed a database of patients who underwent RALP at our institution from January 2004 to September 2007 and identified patients with BNC or complications related to the use of HOLC. We performed a retrospective chart review to attempt to determine the cause of each BNC. We also performed a PubMed search and review of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database.


RESULTS
Of 524 patients undergoing RALP, 4 had a BNC develop, 2 of the BNCs were associated with HOLC migration and erosion into the vesicourethral anastomosis, and 1 was found to have HOLC migration within the bladder. A fifth patient had an anastomotic leak develop secondary to a HOLC that migrated into the bladder neck. Two similar cases of HOLC-related migration have been reported to MAUDE.


CONCLUSIONS
When early BNC or unexplained urinary retention occurs after RALP, one should have a high index of suspicion for migration of HOLC. Clip use should be minimized on tissue immediately adjacent to the anastomosis, and every effort should be made to retrieve loose clips after the procedure.
Blumenthal
Kevin B
KB
Department of Urology, the George Washington University Hospital, Washington, District of Columbia 20037, USA.
Sutherland
Douglas E
DE
Wagner
Kristofer R
KR
Frazier
Harold A
HA
Engel
Jason D
JD
D003286:Contracture / Q000209:etiology; D005548:Foreign-Body Migration / Q000150:complications; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy; D012371:Robotics; D013525:Surgical Instruments / Q000009:adverse effects*; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology*