Two Patients with Neobladder Stones: What Could Be More Peculiar?

Abstract

Objective:

To report two cases of neobladder stone formation due to intravesical Hem-O-lok clips and to review the literature concerning this condition.

Method:

Two patients who were diagnosed to have muscle-invasive transitional cell carcinoma of the bladder underwent radical cystoprostatectomy, followed by orthotopic bladder reconstruction by the Studer pouch. On CT scans 1-year postoperation, there were stones in their neobladders. Cystolithotripsy was performed using ultrasonic lithotripter and Holmium laser, revealing Hem-O-lok clips as the core of the neobladder stones.

Results:

Intravesical migration of Hem-O-lok clips was reported in seven articles including 12 patients. All of them underwent radical prostatectomy. Our two patients, with neobladder stones associated with Hem-O-lok clips after radical cystoprostatectomy, were unprecedented. All patients with intravesical Hem-O-lok clips presented within 1-year postoperation, with lower urinary tract symptoms, acute urinary retention, hematuria, or incontinence. Majority of these patients had bladder neck contracture or associated bladder stones.

Conclusion:

Judicious use of Hem-O-lok clips, especially near the site of vesicourethral anastomosis, will minimize the risk of intravesical migration of Hem-O-lok clips. An early occurrence of neobladder stone, lower urinary tract symptoms, or bladder neck contracture might indicate the presence of intravesical Hem-O-lok clips.

No competing financial interests exist.

Runtime of video: 7 mins 42 secs