Migration of Hem-O-Lok in Pelvicaliceal System Mimicking Renal Calculus Following Robotic Nephron-Sparing Surgery: A Case Report with Review of Literature

Background: Migration of Hem-O-Lok clips in pelvicaliceal system after nephron-sparing surgery (NSS) is rare. We present a rare case of clip migration 8 years after robotic NSS. Case Presentation: A 61-year-old female presented with right flank pain and fever 8 years after robotic NSS for clear cell carcinoma. She was reported to have an 11 mm right renal calculus (570 HU) on CT scan. She underwent flexible ureteroscopy that revealed three Hem-O-Lok clips with encrustations. We removed the clips after laser lithotripsy of the encrusted clips. She is now asymptomatic on follow-up. Conclusion: The possibility of intrarenal migration of Hem-O-Lok clips should be kept as differential diagnosis for patients presenting as renal calculus postminimal access NSS. They could act as nidus for stone formation, leading to recurrent urinary infection. Excessive tension on renorrhaphy sutures should be avoided to prevent migration of clips. The underrunning of any clip in the renal bed during reconstruction should be the standard of care.

Keywords: Hem-O-Lok; NSS; migration; partial nephrectomy; robotic.