Inguinal Herniation Containing Bladder, Causing Contralateral Allograft Hydroureteronephrosis—A Case Report and Literature Review

Abstract

We report the first documented case of an inguinal hernia containing bladder, resulting in contralateral allograft hydroureteronephrosis. A 39-year-old male patient presented with allograft dysfunction, a contralateral inguinoscrotal hernia, and marked hydroureteronephrosis on ultrasound (US). Percutaneous nephrostogram and a retrograde cystogram suggested bladder herniation with incorporation of the contralateral ureteroneocystostomy into the hernia. Paraperitoneal bladder herniation was confirmed at surgery and hernioplasty was performed. Six-week follow-up revealed normal renal function with no sign of hernia recurrence. Despite occurring rarely, transplant ureter or bladder herniation should be considered in the differential diagnosis of hydroureteronephrosis. This case illustrates that the contralateral position of hernia to allograft does not necessarily preclude the hernia as the source of ureteric obstruction.

As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia

“…The inguinal herniation of the transplant ureter in our patient was ultimately diagnosed by abdominal computed tomography. It is important to note that inguinal herniation of a transplant ureter can be accompanied by bladder herniation contralateral to the allograft, 19 - 20 although this was not the case in our patient as his hernia was ipsilateral to the allograft. A review of previously published case reports suggests several risk factors for the development of inguinal herniation of the transplant ureter that were also present in our patient, including male sex, 1 - 20 age 50 years or greater, 1 , 3 , 5 - 7 , 9 - 12 , 14 , 15 , 17 , 19 , 20 and having had a kidney transplant for at least 5 years.…”

“…It is important to note that inguinal herniation of a transplant ureter can be accompanied by bladder herniation contralateral to the allograft, 19-20 although this was not the case in our patient as his hernia was ipsilateral to the allograft. A review of previously published case reports suggests several risk factors for the development of inguinal herniation of the transplant ureter that were also present in our patient, including male sex, 1-20 age 50 years or greater, 1,3,5-7,9-12,14,15,17,19,20 and having had a kidney transplant for at least 5 years. 2-15,17-20 Other risk factors for inguinal herniation of a transplant ureter may include an excessive ureteral length, 3,12-14 placement of the donor ureter anterior to the spermatic cord, 3,13,14 and obesity, …”

“…Our case represents an uncommon cause of ureteral obstruction and acute kidney allograft dysfunction from inguinal herniation of a transplant ureter, with 21 reported cases in the literature. 1 - 20 This case highlights several learning points. Awareness of transplant ureteral obstruction is important because it is a cause of acute kidney allograft dysfunction that can easily be missed.…”

“…Management of transplant ureteral obstruction varies among institutions but can include ureteral stenting 1 , 3 , 6 , 8 , 9 , 10 - 12 , 19 to minimize allograft dysfunction and allow for its identification and isolation during inguinal hernia repair. Nephrostomy insertion may also be necessary for immediate decompression of the collecting system to prevent irreversible graft dysfunction, 1 - 4 , 6 , 8 - 12 , 15 , 17 , 19 , 20 while awaiting definite management with hernia repair but was not required in our patient as his creatinine declined following ureteral stent insertion and he underwent a timely hernia repair 5 days after the hernia was diagnosed. Although rare, the important takeaway message is that transplant ureteral obstruction be recognized in the differential diagnosis of hydronephrosis and acute kidney allograft dysfunction for prompt evaluation and the prevention of graft loss.…”

Contralateral inguinal herniation of a transplant ureter causing obstructive uropathy in a renal transplant recipient

“…In all reported cases, herniation of the transplant ureter occurred into the ipsilateral inguinal canal. The first case of obstructive uropathy caused by contralateral inguinal herniation of the transplant ureter and bladder has been recently reported by du Toit et al 15 in a 39-year-old man 11 years post-transplant. To the best of our knowledge, this report represents the second such case and highlights several learning points.…”