Obstructive uropathy due to uretero-inguinal hernia: An uncommon occurrence

Abstract

Obstructive uropathy secondary to uretero-inguinal hernia is a rare phenomenon. Two types have been described-the rarer extraperitoneal type is frequently associated with other renal anomalies. Pre-operative diagnosis is essential in order to reduce the risk of ureteric injury intra-operatively. We describe one such case.

Obstructive Uropathy Secondary to Uretero-inguinal Hernia

“…[ 2 ] During herniorrhaphy, the ureter is carefully dissected from the hernia sac and returned to the retroperitoneal compartment. [ 5 ] In our case, clinical management of the hernia and associated left-sided obstructive uropathy was further complicated by the presence of a renal cell carcinoma on the right kidney.…”

“…[ 4 ] While several cases of uretero-inguinal hernia reported in literature were identified preoperatively during radiological investigation for urinary symptoms,[ 1 3 4 ] a number of cases have also been diagnosed during hernia repair. [ 3 4 ] Previous reports have emphasized the importance for pre-operative diagnosis to reduce the risk of ureteral injury during surgery,[ 3 4 5 ] although this can be challenging if the patient is not acutely symptomatic. A degree of clinical suspicion is, therefore, required in patients presenting with renal function deterioration on a background of known hernia.…”

“…[ 3 ] If present, management of obstructive uropathy includes insertion of a nephrostomy tube or nephroureteral stent. [ 10 ] Stent insertion enables identification and protection of the ureter during herniorrhaphy,[ 5 ] but endourologic insertion of the stent can be technically difficult due to the length and tortuosity of the ureter. [ 2 ] During herniorrhaphy, the ureter is carefully dissected from the hernia sac and returned to the retroperitoneal compartment.…”

Obstructive uropathy secondary to a ureteral paraperitoneal inguinoscrotal hernia in a patient with a pelvic ectopic solitary kidney and malrotation: a case report and review of the literature

“…Ureteral inguinoscrotal hernias (UISH) are rare, with less than 140 cases reported in the literature [1]. They are more common in obese men and kidney transplant recipients between the fifth and sixth decades of life; right-sided involvement is predominant [2][3][4][5]. The paraperitoneal and extraperitoneal subtypes have been described, the latter related to urinary tract abnormalities.…”

Obstructive Uropathy Due to an Incarcerated Ureteroinguinal Hernia

“…The herniated ureter is accompanied only by retroperitoneal fat [7]. Anomalies of the urinary system (for example, ptosis of the kidney) are common in these cases (46%) and imaging of the urinary tract is indicated even when the ureteral hernia is incidentally discovered at surgery [4,8]. Both the paraperitoneal and extraperitoneal hernias are predominantly indirect.…”