# Bladder Stone Formation on Migrated Hem-o-Lok Clips at the Vesicourethral Anastomosis After Robot-Assisted Radical Prostatectomy: A Case Report

## TL;DR

A rare case of bladder stones forming on surgical clips used during prostate cancer surgery is reported, highlighting the long-term complications and management.

## Contribution

This case report presents a rare complication of migrated Hem-o-Lok® clips and proposes an alternative technique for their removal.

## Key findings

- Bladder stones formed on migrated Hem-o-Lok® clips four years after RARP.
- Endoscopic management was used to remove the stones and clips safely.
- An alternative mechanical technique is suggested to prevent recurrence and injury.

## Abstract

Robot-assisted radical prostatectomy (RARP) is a well-established surgical treatment for localized prostate cancer, offering excellent oncologic outcomes with reduced perioperative morbidity compared to open surgery. Hem-o-Lok® clips are routinely used during RARP to achieve hemostasis and facilitate precise dissection of the prostatic pedicles. Although generally safe, migration of these non-absorbable clips to the vesicourethral anastomosis represents an uncommon but clinically relevant late complication. Once exposed to urine, migrated clips may serve as a nidus for encrustation and subsequent stone formation, resulting in hematuria or lower urinary tract symptoms (LUTS) that may manifest months or even years after surgery. We present a rare case of bladder stone formation on migrated Hem-o-Lok® clips at the vesicourethral anastomosis four years following RARP, highlighting its clinical presentation, diagnostic workup, endoscopic management, and an alternative mechanical technique for complete clip removal aimed at minimizing the risk of anastomotic injury and recurrence.