Presentation, Endoscopic Management, and Significance of Hemostatic Clip Migration into the Lower Urinary Tract Following Radical Prostatectomy

Christopher D. Jaeger, Patrick A. Cockerill, Matthew T. Gettman, Matthew K. Tollefson

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: 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. Patients and 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.

Original languageEnglish (US)
Pages (from-to)800-803
Number of pages4
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume25
Issue number10
DOIs
StatePublished - Oct 1 2015

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Hemostatics
Prostatectomy
Urinary Tract
Surgical Instruments
Contracture
Urinary Bladder
Hematuria
Pain
Infection
Anxiety

ASJC Scopus subject areas

  • Surgery

Cite this

Presentation, Endoscopic Management, and Significance of Hemostatic Clip Migration into the Lower Urinary Tract Following Radical Prostatectomy. / Jaeger, Christopher D.; Cockerill, Patrick A.; Gettman, Matthew T.; Tollefson, Matthew K.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 25, No. 10, 01.10.2015, p. 800-803.

Research output: Contribution to journalArticle

Jaeger, Christopher D. ; Cockerill, Patrick A. ; Gettman, Matthew T. ; Tollefson, Matthew K. / Presentation, Endoscopic Management, and Significance of Hemostatic Clip Migration into the Lower Urinary Tract Following Radical Prostatectomy. In: Journal of Laparoendoscopic and Advanced Surgical Techniques. 2015 ; Vol. 25, No. 10. pp. 800-803.
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abstract = "Objectives: 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. Patients and 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.",
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