Migration of a Hem-o-Lok Clip to the Ureter Following Laparoscopic Partial Nephrectomy Presenting With Lower Urinary Tract Symptoms
A 37-year-old woman presented to us complaining of sudden right flank pain and lower abdominal pain that had lasted for 1 week, as well as nausea and vomiting. Two years previously she had undergone a laparoscopic right partial nephrectomy at another hospital owing to a small right renal mass that was diagnosed as renal cell carcinoma (T1aN0M0). Postoperatively, she had gradually acquired lower urinary tract symptoms, such as urge incontinence, urgency, frequency, and nocturia. Three months earlier, she had been checked with abdominopelvic computed tomography (CT) for regular follow-up of the renal cell carcinoma and heard that there were no definite abnormal findings in the CT scan. In the physical examination, right costovertebral angle tenderness was observed. The results of a urine test showed 5 to 10 red blood cells per high power field, and plain X-ray of the kidney, ureter, and bladder revealed metallic surgical clips on the right upper abdomen and a possible right renal stone, but no abnormal density on the ureteral courses (). The abdominopelvic CT scan revealed a 0.5 cm×1.0 cm opacity on the right proximal ureter with borderline hydronephrosis and a tiny right renal stone (). Ureteroscopy with the patient under general anesthesia showed a white rectangular parallelepiped foreign body at the proximal right ureter (). The foreign body was removed by use of a ureteroscopic stone basket device and was identified as a medium-sized surgical clip (). There was no extravasation of the renal pelvis during contrast media instillation via the channel of the ureteroscope. A ureteral stent was placed for 1 week, and the patient had no more flank pain.