title: Presentation, Endoscopic Management, and Significance of Hemostatic Clip Migration into the Lower Urinary Tract Following Radical Prostatectomy.
abstract: OBJECTIVE
  Hemostatic clip migration into the lower urinary tract is a potential complication of radical prostatectomy that may cause symptoms, anxiety, and functional concern. Our objective was to evaluate initial presentation, endoscopic management, and outcomes of patients with hemostatic clip migration following radical prostatectomy.
  
  
  METHODS
  We retrospectively identified all patients with hemostatic clip migration at our institution from 1977 to 2012. Patient records were then reviewed to identify causative factors, presentation, and long-term functional outcomes.
  
  
  RESULTS
  Seventeen patients were identified with clip migration following radical prostatectomy. Eight (47%) patients had undergone open retropubic radical prostatectomy, and 9 (53%) had received robot-assisted radical prostatectomy. Hemostatic clip migration was diagnosed at a median of 8 (range, 1-252) months after prostatectomy. The majority of patients (n = 16, 94%) were symptomatic upon the diagnosis of clip migration. Symptoms included irritative urinary symptoms (n = 14, 82%), perineal pain (n = 3, 18%), hematuria (n = 2, 12%), and infection (n = 2, 12%). Five (29%) had concomitant bladder neck contracture. Fifteen (88%) underwent successful endoscopic clip removal, whereas 2 (13%) patients required a repeat operation for recurrent clip erosion. With a median follow-up of 1.6 years, the majority (n = 13, 87%) had complete symptom resolution after clip removal, although 2 patients had recurrent bladder neck contracture.
  
  
  CONCLUSIONS
  Hemostatic clip migration after prostatectomy is often symptomatic with irritative voiding complaints, perineal pain, hematuria, infection, or bladder neck contracture. Fortunately, clips can be removed endoscopically with expected symptom resolution in the vast majority of patients.
authors.affiliation: Department of Urology, Mayo Clinic School of Medicine , Rochester, Minnesota.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Jaeger
authors.affiliation: Department of Urology, Mayo Clinic School of Medicine , Rochester, Minnesota.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Cockerill
authors.affiliation: Department of Urology, Mayo Clinic School of Medicine , Rochester, Minnesota.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.affiliation: Department of Urology, Mayo Clinic School of Medicine , Rochester, Minnesota.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
mesh_terms: D000368:Aged; D003286:Contracture / Q000209:etiology* / Q000601:surgery; D020878:Device Removal; D053159:Dysuria / Q000209:etiology / Q000601:surgery; D004724:Endoscopy; D006417:Hematuria / Q000209:etiology / Q000601:surgery; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects*; D001743:Urinary Bladder; D014552:Urinary Tract Infections / Q000209:etiology / Q000601:surgery; D014555:Urination Disorders / Q000209:etiology* / Q000601:surgery