Urolithiasis secondary to Hem-o-lok partial migration into renal calyx as a long-term complication of robotic partial nephrectomy: a case report and literature review

Abstract

Background: Hem-o-lok clips (HOLCs) are a useful tool in mini-invasive surgery, especially for renal surgery. However, in rare cases they could migrate into the collecting system and be calculogenic. Case presentation: we present a case of a 53 years old man with an incidental CT finding of a left renal stone increasing its size in the last 2 years. He had a medical history of ipsilateral robotic partial nephrectomy at another institution 8 years before. The stone was located in the upper calyx. He underwent a flexible ureteroscopy. After an initial fragmentation a Hem-o-lok was reported, partially wedged into the renal parenchyma. After the removal of the HOLC with a basket it was observed a small urinary leak, managed with a JJ stent placement. In the postoperative period the patient had fever managed with antibiotics and was discharged in the 4th postoperative day without problems. Conclusions: HOLC migration into the collecting system is a rare complication following robotic and laparoscopic renal surgery. HOLC could act as a nidus for stone formation. Avoiding too much tension during renal suture using HOLC could reduce the possibility of migration. Simple knotting in particular conditions is a useful option. However, this kind of stones can be managed endoscopically without particular complaints, minding the possibility that HOLC could be partially wedged into renal parenchyma leading to urinary leak.