Late‐onset Hem‐o‐Lok® migration into the bladder after robot‐assisted radical prostatectomy

Hem‐o‐Lok ® clips are widely used in robot‐assisted radical prostatectomy because of their ease of application and secure clamping. Although there have been some reports of their migration into the urinary tract, this usually occurs a few months after robot‐assisted radical prostatectomy. Late‐onset cases of Hem‐o‐Lok ® clip migration, that is, after more than 1 year, are rare. Case presentations We report three cases of delayed endourethral Hem‐o‐Lok ® clip migration more than 2 years after robot‐assisted radical prostatectomy. The Hem‐o‐Lok ® clips were almost completely endoluminal, and were attached at one end to the vesicourethral anastomosis. We successfully removed them via transurethral surgery using a holmium laser. Conclusion This case series describes late‐onset Hem‐o‐Lok ® clip migration into the bladder more than 1 year after robot‐assisted radical prostatectomy. Transurethral holmium laser surgery was very effective for Hem‐o‐Lok ® clip removal. To avoid involvement of Hem‐o‐Lok ® clips in the vesicourethral anastomosis, appropriate resection at the time of bladder neck transection is important.