Báo cáo trường hợp phát hiện Hem-o-lok clip trong bể thận hình thành sỏi thứ phát

Abstract

Introduction: Non-absorbable foreign bodies in the urinary tract for a long time may act as a nidus for secondary nephrolithiasis. The risk of migration of Hem-o-Lok clips (HOLCs) into the renal pelvis is rare. We found only a few cases described in the literature, primarily following partial nephrectomy. To our knowledge, no such cases have been reported in Vietnam. Case presentation: A 50-year-old female with a history of retroperitoneal laparoscopic nephrolithotomy for a right renal stone four years ago. This patient was diagnosed with recurrent right renal stones. She underwent mini-percutaneous nephrolithotomy (mPCNL), and a HOLC was discovered inside the stone, with part adherent to the renal pelvis. The HOLC and renal calculi were removed. The procedure was completed safely, without complications. Clinical discussion: Several reports have documented non-absorbable material in the renal pelvis to form secondary renal stones. In particular, HOLCs used for hemostasis during partial nephrectomy have been shown to migrate into the collecting system and form secondary renal stones. In this case, HOLC may have been clipped in the renal pelvis during retroperitoneal laparoscopic nephrolithotomy for a right renal stone four years ago, and/or it may have migrated into the renal pelvis and formed secondary renal calculi. Conclusion: The presence of HOLC in the renal pelvis, causing renal stone formation, is a rare but clinically significant complication. This case highlights the importance of avoiding clips that may migrate as HOLC into the renal pelvis and ensuring that any misplaced or loosened HOLC are removed intraoperatively to reduce the risk of migration and prevent recurrent nephrolithiasis.