V08_No_2_Final.pdf Case Report 153Urology Journal Vol 8 No 2 Spring 2011 Spontaneous Migration of a Surgical Clip Following Partial Nephrectomy Walid Atef Massoud Urol J. 2011;8:153-4. www.uj.unrc.ir Keywords: nephrectomy, renal colic, urinary tract Department of Urology, 78, rue du général Leclerc, 94275 Le Kremlin- Bicêtre, France Corresponding Author: Walid Atef Massoud, MD Department of Urology, 78, rue du général Leclerc, 94275 Le Kremlin- Bicêtre, France Tel: +33 699 114 939 Fax: +33 145 212 047 E-mail: walidmassoud@yahoo.fr Received August 2009 Accepted March 2010 INTRODUCTION Migration of surgical materials into the urinary tract is a rare condition. We present a case of spontaneous migration of a metal clip into the ureter 9 years after upper pole partial nephrectomy. CASE REPORT A 48-year-old woman presented with a sudden right flank pain radiating to her right groin. She was found to have a 5-cm upper pole angiomyolipoma of the right kidney 9 years earlier. Therefore, she had undergone open partial nephrectomy. Violation of the collecting system had been repaired using a 3-0 Vicryl. Tightness had been checked by administrating Indigo carmine through a ureteral stent. Surgical bed hemostasis had been achieved by 2-0 Vicryl running sutures and automatic nonabsorbable surgical clips (Autosuture Premium Surgiclip). The parenchymal bed had been then covered by absorbable bolsters. The postoperative course was uneventful and the patient had been discharged from the hospital. Plain radiography of the kidney, ureter, and bladder demonstrated a 4-mm opacity projected over the pelvic portion of the right ureter as well as multiple additional small opacities bordering and within the partial nephrectomy site (Figure 1). Spiral abdomino pelvic computed tomography scan confirmed the diagnosis of right renal colic following migration of a Figure 1. Kidney, ureter, and bladder x-ray showing surgical clips projected within the partial nephrectomy area and the right distal part of the ureter. Surgical Clip Migration—Massoud 154 Urology Journal Vol 8 No 2 Spring 2011 surgical clip (Figure 2). The patient was managed conservatively with hydration and narcotic analgesia. Few days later, the patient passed the clip spontaneously. DISCUSSION Migration of clips into the common bile duct has been previously reported in several laparoscopic cholecystectomies.(1,2) Furthermore, it has been reported that surgical clips can act as a nidus for stone formation when they are in contact with urine.(3) In this patient, nonabsorbable surgical clip has probably eroded into the collecting system. A similar case with absorbable Lapra-Ty suture clips (Ethicon Endosurgery, Cincinnati, Ohio) has been reported by Miller and colleagues.(4) Several cases of surgical clip migration into the bladder following retropubic radical prostatectomy have been reported.(5) Long and associates reported a 61-year-old man who had undergone radical prostatectomy for localized prostate cancer. The postoperative course was marked by recurrent urinary retention and several urethrotomies failed to restore spontaneous voiding. A clip was finally visualized and removed by endoscopy.(6) Metal clips may migrate postoperatively and cause secondary complications. Therefore, they should be absorbable and applied selectively over vessels and far from the collecting system. CONFLICT OF INTEREST None declared. REFERENCES 1. Dell’Abate P, Del Rio P, Soliani P, Colla G, Sianesi M. Choledocholithiasis caused by migration of a surgical clip after video laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2003;13:203-4. 2. Yoshizumi T, Ikeda T, Shimizu T, et al. Clip migration causes choledocholithiasis after laparoscopic cholecystectomy. Surg Endosc. 2000;14:1188. 3. Gronau E, Pannek J. Reflux of a staple after kock pouch urinary diversion: a nidus for renal stone formation. J Endourol. 2004;18:481-2. 4. Miller M, Anderson JK, Pearle MS, Cadeddu JA. Resorbable clip migration in the collecting system after laparoscopic partial nephrectomy. Urology. 2006;67:845 e7-8. 5. Kadekawa K, Hossain RZ, Nishijima S, et al. Migration of a metal clip into the urinary bladder. Urol Res. 2009;37:117-9. 6. Long B, Bou S, Bruyere F, Lanson Y. [Vesicourethral anastomotic stricture after radical prostatectomy secondary to migration of a metal clip]. Prog Urol. 2006;16:384-5. 7. Blumenthal KB, Sutherland DE, Wagner KR, Frazier HA, Engel JD. Bladder neck contractures related to the use of Hem-o-lok clips in robot-assisted laparoscopic radical prostatectomy. Urology. 2008;72:158-61. 8. Tugcu V, Polat H, Ozbay B, Eren GA, Tasci AI. Stone formation from intravesical Hem-o-lok clip migration after laparoscopic radical prostatectomy. J Endourol. 2009;23:1111-3. Figure 2. Spiral pelvic computed tomography scan demonstrating a 4-mm opacity in the lumen of the right pelvic ureter.