Percutaneous Nephrolithotomy Removal of Eroded Hem-o-lok Clip Post-Partial Nephrectomy

Abstract

Clinical History: This video is a demonstration of the removal of an eroded Hem-o-lok clip post-partial nephrectomy through percutaneous nephrolithotomy (PCNL). The index patient is a 69-year-old gentleman, who received robotic partial nephrectomy 10 years ago for a right kidney lower pole renal cell carcinoma. Later he was presented with hematuria. Physical Examination: Physical examination was unremarkable. Diagnosis: A computer tomography scan discovered an eroded Hem-o-lok clip into the system at lower pole of the right kidney. There were associated stones. Otherwise, there was no other lesion in the urinary system explaining his symptoms. Intervention: Retrograde intrarenal surgery (RIRS) was performed but failed to access the lower pole Hem-o-lok and the associated stones. PCNL was attempted with modified prone position. Antegrade access with ultrasound-guided upper pole puncture was performed. Upper pole was punctured as it allows access to all calixes, including the lower pole, and also because of the distorted anatomy after partial nephrectomy observed in fluoroscopy in the previous RIRS. Holmium laser was employed for disengagement of the clip from surrounding mucosa. Stones were fragmented with Lithoclast lithotripter. Clip and the related stones were removed with forceps. Follow-Up/Outcomes: Patient was discharged one day postoperation and the pelvicaliceal system was clear of stones on a later computed tomography scan. Removal of eroded surgical clips endourologically with PCNL is a safe and possible method. No competing financial interests exist. Runtime of video: 4 mins 34 secs Patient Consent Statement: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.