Robotic prostate removal, also known as robot-assisted radical prostatectomy, is a well-established and widely used operation for prostate cancer. For most men, it offers excellent long-term cancer control with good functional outcomes.
Like all surgeries, however, it can be associated with late complications. One of the least discussed but increasingly recognised in the medical literature is the migration of surgical clips.
This article explains what migrating clips are, why they occur, how common they are, what symptoms men may notice, and how the condition is diagnosed and treated. The aim is to provide clear, evidence-based reassurance while addressing a fundamental and often overlooked cause of late urinary symptoms.
What are surgical clips used for during robotic prostate surgery?
During robotic prostate removal, surgeons must control bleeding from blood vessels around the prostate.
To do this safely, surgical clips are often used.
- They are small, non-absorbable polymer devices
- Commonly known as Hem-o-Lok clips
- They close blood vessels without using heat
Why this matters:
Avoiding heat near delicate structures helps protect:
- Urinary control
- Erectile nerves
- Surrounding pelvic tissues
In the vast majority of men, these clips remain permanently in place and cause no problems at all.
Can surgical clips really move after robotic prostate removal?
Yes. Clip migration refers to a surgical clip moving from its original position into a nearby structure.
After prostate surgery, clips may rarely migrate into:
- The bladder
- The urethra (the tube that carries urine)
- The vesicourethral anastomosis (the join between the bladder and urethra)
Once exposed to urine, a clip can:
- Cause local inflammation
- Act as a focus for stone formation
- Lead to scarring or narrowing of the urine channel
How common is clip migration after robotic prostatectomy?
The strongest data come from a large published cohort of 682 men who underwent robotic prostate removal.
- 26 men developed clip migration
- This represents an incidence of 3.8%
- Time to diagnosis ranged from 1 to 37 months
- The average time to detection was 13 months after surgery
Prior literature underestimated this risk because it relied primarily on isolated case reports rather than on systematic follow-up.
Where do migrating clips go after prostate surgery?
In published studies:
- 84% migrated into the bladder–urethra junction
- 8% migrated into the urethra
- 8% migrated into the bladder itself
Notably, 73% of migrated clips had stone formation on their surface, explaining why symptoms often worsen gradually rather than appearing suddenly.
What symptoms can migrating surgical clips cause?
Men usually present with new or unexplained urinary symptoms, often long after they believe recovery is complete.
Common symptoms include:
- Weak or slowing urine flow
- Increased urinary frequency
- Urgency
- Blood in the urine
- Recurrent urinary tract infections
- Bladder stones
- Difficulty emptying the bladder
- Episodes of urinary retention
Symptoms may appear months or even many years after surgery, including very delayed presentations over 10 years later.
How long after prostate surgery can clip migration occur?
Clip migration has been reported:
- As early as 1 month after surgery
- Most commonly within the first 1–2 years
- Occasionally, many years later
This delayed onset is one of the main reasons the diagnosis is often missed.
Why do surgical clips migrate after robotic prostate surgery?
Clip migration is thought to be related to how tissues heal at the bladder–urethra join.
Proposed mechanisms include:
- Reduced blood supply (ischaemia)
- Inflammation or infection
- Urine leakage after surgery
- Tissue breakdown followed by scarring
Poor healing may allow clips placed near the junction to gradually erode into the urinary tract.
Who is more likely to develop clip migration after prostatectomy?
Extensive cohort data show a higher risk in men who experienced:
- Urine leakage after surgery
- 15% versus 6% in men without migration
- Bladder–urethra narrowing (anastomotic stenosis)
- 54% versus 5%
- Longer initial hospital stay
- Positive surgical margins at the urethral apex
Clip migration was not linked to cancer stage, PSA level, blood loss, or length of surgery.
Can migrating clips cause bladder neck narrowing or strictures?
Yes, and this is one of the most critical consequences.
- More than half (54%) of men with migrating clips developed narrowing at the bladder–urethra junction
- Some required further endoscopic treatment.
This explains why men may notice progressively worsening urine flow after an initially successful operation.
How are migrating clips diagnosed after prostate surgery?
The most reliable test is cystoscopy.
This involves passing a small camera through the urethra to:
- Directly visualise the clip
- Identify stones or inflammation
Scans alone may appear normal, which is why cystoscopy is essential when symptoms persist.
What treatments are available for migrated surgical clips?
Treatment is usually minimally invasive and highly effective.
Standard treatment includes:
- Endoscopic removal using cystoscopy
- Laser fragmentation if stones have formed
- Temporary catheterisation if required
Most men recover quickly, symptoms resolve, and recurrence is uncommon.
Can surgical clips migrate outside the urinary tract?
Very rarely, the published medical literature reports clips migrating beyond the urinary system, including isolated cases involving the rectum or adjacent tissues.
These cases are exceptional, and when identified, removal is usually straightforward. Cancer outcomes are not affected.
Can clip migration be prevented during robotic prostate removal?
Evidence suggests surgical technique plays an important role.
Risk-reduction strategies include:
- Limiting the number of clips used
- Avoiding clip placement near the bladder–urethra junction
- Using sutures instead of clips near the prostate apex
- Minimising electrical energy near healing tissue
These refinements have been associated with a marked reduction in new cases.
Are surgeons now performing clipless robotic prostatectomy?
Yes. In response to complications such as clip migration, some surgeons have adopted clipless or reduced-clip robotic prostatectomy techniques.
What does “clipless” mean?
- Minimal or no use of non-absorbable clips
- Greater reliance on suturing and selective energy sealing
- Reduced foreign material near the bladder–urethra junction
Why this matters
- Less foreign material may improve tissue healing
- Reduced risk of late complications such as migration, strictures, and stones
- Reflects ongoing refinement of robotic prostate surgery
Clipless approaches are not suitable for every patient, but they highlight the direction of modern surgical practice.
Why are migrating surgical clips often missed
This complication is frequently overlooked because:
- Symptoms mimic common bladder conditions
- Onset can be delayed by years
- Routine imaging may be normal
- Clips are assumed to be inert
As a result, symptoms may be misattributed to ageing or prior surgery without further investigation.
What this means for men after robotic prostate removal
- Clip migration is uncommon but real
- Symptoms may appear long after surgery
- Blood in the urine, infections, or worsening flow deserve investigation
- Diagnosis is straightforward
- Treatment is usually simple and effective
- Cancer control is not affected
Key take-home message on migrating clips after robotic prostate surgery
Migrating surgical clips after robotic prostate removal are rare but can explain late or persistent urinary symptoms. When recognised, they are highly treatable and do not indicate cancer recurrence.
Frequently Asked Questions about Migrating Surgical Clips After Robotic Prostate Surgery
Can surgical clips really move after robotic prostate surgery?
Yes. Surgical clips can rarely migrate after robotic prostate removal due to tissue healing changes near the bladder–urethra junction.
How common is clip migration after robotic prostatectomy?
Extensive studies indicate that it occurs in approximately 3–4% of men.
How long after surgery can clip migration happen?
From as early as one month to many years later, including cases exceeding 10 years.
What symptoms suggest a migrating clip?
Poor flow, urgency, blood in the urine, infections, bladder stones, or difficulty emptying the bladder.
Does clip migration indicate cancer recurrence?
No. It is a mechanical complication and not linked to cancer recurrence.
