title: Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.
abstract: BACKGROUND
  Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence.
  
  
  METHODS
  A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged.
  
  
  CONCLUSIONS
  The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, viale Luigi Pinto 1, 71121 Foggia, Italy. luigicormio@libero.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cormio
authors.forename: Paolo
authors.initials: P
authors.lastname: Massenio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Fino
authors.forename: Oscar
authors.initials: O
authors.lastname: Selvaggio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrieri
mesh_terms: D003286:Contracture / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D020878:Device Removal; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000295:instrumentation; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D012371:Robotics / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013525:Surgical Instruments / Q000009:adverse effects*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology* / Q000473:pathology / Q000601:surgery*