U ISSN 0391-5603 Urologia ( 2014 ; 00 ): 000=000 00 © 2014 Wichig Publishing CASE REPORT with 3-0 vicryl suture. Vesico-urethral anastomosis (VUA) was completed using a 3-0 vicryl interrupted suture. Pathology showed a Gleason score of 4 + 3 = 7 with posiive margins, no extracapsular extension, negaive lymph nodes, no seminal vesicle invasion, and no angiolymphaic invasion. His post- operaive recovery course was unremarkable. His Foley cath- eter was removed 9 weeks ater surgery because of a urine leakage showed at a postoperaive cystogram. Ater surgery, paient underwent adjuvant pelvic radiotherapy (RT) from September 2013 to January 2014. Ater an iniial comfortable voiding, about 1 year ater surgery, the paient began complaining of dysuria, nicturia, frequency, and hematuria. He was fully coninent and serum PSA was less than 0.01 ng/ml. A pelvic magneic resonance DOI: 10.5301/uro.5000106 Endourethral migraion of a Hem-o-Lok Cl ip ater robot-assisted laparoscopic radical prostatectomy Riccardo Bieninesi, Luca Di Gianfrancesco, Dario Pugliese, Daniele D’Agosino, Marco Racioppi, Pier Francesco Bassi, Emilio Sacco Department of Urology, “Agosino Gemelli” Hospital - Catholic University Medical School, Rome - Italy Introducion In recent years, robot-assisted laparoscopic radical prostatectomy (RALP) has become a widely accepted mini- invasive surgical alternaive for the treatment of prostate cancer (pCa) (1). During RALP, diferent modaliies are used for hemostasis. The Hem-o-Lok clips (HOLC; Weck Surgi- cal Instruments, Telelex Medical, Durham, North Carolina, USA) are widely used in the control of the lateral vascu- lar pedicles of the prostate during RALP. Their migraion into the urinary tract has already been described (2-11), presening with spontaneous expulsion, urethral erosion, bladder stone formaion, and even bladder neck contrac- ture (BNC). Here, we report a case of urethral migraion of HOLC causing lower urinary tract symptoms (LUTS) and hematuria. Case report A 76-year-old Caucasian man, previously treated with TURP for BPH, in April 2013 underwent RALP to our insitu- ion because of a T1c Gleason score 3 + 4 pCa with a serum PSA of 6 ng/ml at diagnosis. During RALP, we placed three HOLC for hemostasis (two at the let neurovascular bundle, one at the right one; Fig. 1); we also performed cervicoplasty ABStRACt Hem-o-Lok clips (Weck Surgical Instruments, Telelex Medical, Durham, North Carolina, USA) are widely used in robot-assisted laparoscopic radical prostatectomy because of their easy applicaion and secure clamping. To date, there have been some reports of their migraion into the urinary tract, causing urethral erosion, bladder neck contractures orcalculus formaion. We report a case of endourethral migraion of a hem-o-lok ater robot-assisted laparoscopic prostatectomy. The hem-o-lok was almost completely endoluminal and atached to one end at the vesico-urethral anastomosis. The hem-o-lok was easily removed cystoscopically by using an endoscopic forceps. Keywords: Hem-o-Lok, Clip migraion, Roboic radical prostatectomy Accepted: November 7, 2014 Published online: December 5, 2014 Corresponding author: Riccardo Bieninesi Università Catolica del Sacro Cuore L.go F. Vito, 1 Rome 00166, Italy riccardo.bieninesi@gmail.com. Fig. 1 - Hem-o-Lock clips posiion at the end of RALP.