title: Three Types of Intravesical Hem-o-Lok Clip Migration After Laparoscopic Radical Prostatectomy.
abstract: BACKGROUND
  Hem-o-Lok® clips (HOLCs) (Weck® Surgical Instruments, Teleflex Medical, Durham, NC) are widely used for controlling the lateral pedicles in laparoscopic radical prostatectomy, but intravesical HOLC migrations have been reported in more and more studies. This study aimed to summarize clinical presentations, management, and outcomes of these patients.
  
  
  METHODS
  Six patients with intravesical HOLC migration were retrospectively identified from 750 consecutive patients who underwent robot-assisted laparoscopic prostatectomy between 2005 and 2014 performed by a single surgeon. The PubMed database was also searched for Hem-o-Lok clip migration after laparoscopic prostatectomy.
  
  
  RESULTS
  The incidence of intravesical HOLC migration in this study was 0.8% (6/750). In total, 22 patients were reported, including six from the current series. Three types of migrations were classified: Type I migration resulted in obstructive lower urinary tract symptoms 2-8 months after prostatectomy, whereas Type II migration led to stone formation, gross hematuria, or bladder spasm; in Type III migration, patients had spontaneous expulsion of the HOLC weeks after surgery.
  
  
  CONCLUSIONS
  Although the incidence of intravesical HOLC migration is relatively low, Type I migration with long-term sequelae remains a concern. The use of HOLCs adjacent to anastomosis should be minimized, and any loose clip must be retrieved to reduce complications.
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China .
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Yu
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China .
authors.forename: Cheng-Kuang
authors.initials: CK
authors.lastname: Yang
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China .
authors.forename: Yen-Chuan
authors.initials: YC
authors.lastname: Ou
mesh_terms: D000368:Aged; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011468:Prostatectomy / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome