080 Ureteral Herniation Leading to Intermittent Obstructive Uropathy in a Renal Allograft Recipient

Ureteral herniation in kidney transplant - Case Report

“…Nevertheless, one could infer that the chronic exposure to certain immunosuppressant could contribute to this illness, as they may interfere with part of the wound healing process. Among the main clinical features related to this anatomic pathology are previous inguinal surgery, inguinal enlargement, and acute loss of graft function [2,3,[8][9][10]12,14,16,17,20,21,23].…”

“…The main image methods used for the diagnosis are graft ultrasound, abdominal CT, and nefrography [5][6][7][8][9][10][11][16][17][21][22][23]. In five cases, abdominal magnetic resonance was used for the documentation [3,4,9,12,19].…”

“…Over half of the cases describe the positioning of a nephrostomy tube before any surgery in order to prevent any more graft loss [1][2][3][4][5][6][7][8][9][10][11][14][15][16]17]. A pyelography through the nephrostomy tube could allow a refined documentation of the ureterohydronephrosis and of the transplant ureter entrapment in the inguinal canal, even though this procedure would not change clinical or surgical outcome.…”

“…In eight cases the hernia repair was performed without the need of any stenting, since the patients were in good clinical conditions and were already cleared for this type of surgery [9,12,17,[18][19][20]23].…”

Imaging in Kidney Transplantation

“…The major causes of ureteral obstruction are ureteral ischemia, edema at the uretero-vesical anastomotic site, infection, extrinsic compression of the ureter by fluid collections, and ureteral kinking. Other relatively rare causes are stones, papillary necrosis, clots, fungi, pelvic fibrosis, and herniation of the ureter [61]. Early-onset obstruction of the ureter is secondary to kinks, clots, edema, inflammation, or a tight submucosal tunnel.…”