Document Detail


Bladder neck contractures related to the use of Hem-o-lok clips in robot-assisted laparoscopic radical prostatectomy.
MedLine Citation:
PMID:  18372034     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Recently, several large series of robot-assisted laparoscopic radical prostatectomy (RALP) have described a low incidence of bladder neck contractures (BNC). We have had a similar experience at our institution. Our objective is to describe our experience with BNC after RALP and a novel relationship to the use of Hem-o-lok Clips (HOLC). METHODS: We reviewed a database of patients who underwent RALP at our institution from January 2004 to September 2007 and identified patients with BNC or complications related to the use of HOLC. We performed a retrospective chart review to attempt to determine the cause of each BNC. We also performed a PubMed search and review of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. RESULTS: Of 524 patients undergoing RALP, 4 had a BNC develop, 2 of the BNCs were associated with HOLC migration and erosion into the vesicourethral anastomosis, and 1 was found to have HOLC migration within the bladder. A fifth patient had an anastomotic leak develop secondary to a HOLC that migrated into the bladder neck. Two similar cases of HOLC-related migration have been reported to MAUDE. CONCLUSIONS: When early BNC or unexplained urinary retention occurs after RALP, one should have a high index of suspicion for migration of HOLC. Clip use should be minimized on tissue immediately adjacent to the anastomosis, and every effort should be made to retrieve loose clips after the procedure.
Authors:
Kevin B Blumenthal; Douglas E Sutherland; Kristofer R Wagner; Harold A Frazier; Jason D Engel
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Publication Detail:
Type:  Journal Article     Date:  2008-04-18
Journal Detail:
Title:  Urology     Volume:  72     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-07     Completed Date:  2008-08-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  158-61     Citation Subset:  IM    
Affiliation:
Department of Urology, the George Washington University Hospital, Washington, District of Columbia 20037, USA.
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MeSH Terms
Descriptor/Qualifier:
Contracture / etiology
Foreign-Body Migration / complications
Hemostasis, Surgical / instrumentation
Humans
Laparoscopy*
Male
Prostatectomy*
Robotics*
Surgical Instruments / adverse effects*
Urinary Bladder Neck Obstruction / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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