Collateral damage of wandering ProTacks

Case A 75-year-old man presented with mixed obstructive and storage lower urinary tract symptoms (LUTS). He had undergone transurethral resection of the prostate (TURP) 5 years and laparoscopic inguinal hernia repair 20 years ago. He had a stone adherent to the bladder wall and an occlusive prostate. Outcome He underwent a re-do TURP and stone removal. Stone removal revealed an underlying metal coil straddling the bladder wall, which had served as a nidus for stone formation. The metal ring was a ProTack staple from previous hernia surgery, which had detached and wandered into the bladder. At follow-up after 12 weeks, the patient was asymptomatic, and his urine was sterile. Therefore, he chose to be treated conservatively for the ProTack and was started on periodic follow-up and cystoscopic surveillance. Shortly after review, he developed intestinal obstruction, which resolved spontaneously and was thought to be secondary to adhesions from other tacks that had migrated into the peritoneal cavity. Conclusion We have reported a case of a ProTack from a previous hernia repair migrating into the bladder and also causing intestinal obstruction. The case is very rare because of the combination of complications. Clinicians should beware of delayed complications and damage to other organs due to metallic hernia staples.

Automated summary

A 75-year-old man with lower urinary tract symptoms underwent re-do transurethral resection of the prostate (TURP) and stone removal. It was found that a metal staple from a previous hernia repair had migrated into the bladder, causing stone formation. The patient developed intestinal obstruction, possibly due to other migrated staples. This case highlights the importance of being aware of delayed complications and damage from metallic hernia staples.