Scrotal Extraperitoneal Hernia of the Ureter: Case Report and Literature Review

Abstract

Ureteral herniation is a rare, often misdiagnosed event and serious surgical complications are possible. Until 1992, 128 cases of ureteral herniation were reported and in 54 (42%) the inguino-scrotal region was involved. From an anatomical and pathogenic standpoint, two types of uretero-inguinal hernias can be identified: paraperitoneal (more frequent, acquired, always presenting a peritoneal hernia sac, frequently associated with other herniated abdominal structures) and extraperitoneal (very uncommon, congenital, never associated with a true peritoneal sac, always composed only of the ureter). We describe a new case of scrotal extraperitoneal ureteral hernia and review the current urological, surgical and radiological literature to analyze the main clinical characteristics of this pathology and its ideal treatment.

Inguinoscrotal hernias involving urologic organs: A case series

“…The two types of ureteroinguinal herniations described in the literature are paraperitoneal and extraperitoneal. 10 Paraperitoneal hernias comprise 80% of inguinoscrotal ureteric hernias and are thought to arise due to adherence of the ureter to the hernia sac posteriorly. 10 Extraperitoneal hernias comprise 20% of ureteroinguinal hernias and contain the ureter without any hernia sac.…”

Robot-Assisted Laparoscopy Repair for a Supra-Piriform Herniation of the Pelvic Ureter

“…By frequency argument, the ureteral involvement by hernia in women is rather of femoral and inguino-scrotal seat in the man [5]. From difficult diagnosis, it can be responsible for chronic pain in women.…”

Obstructive Uropathy Due to an Incarcerated Ureteroinguinal Hernia

“…Ureteroinguinal hernias are treated surgically because of the risk of obstructive uropathy. Herniorrhaphy with simple reduction of the ureter may be performed, or resection of the redundant ureter followed by primary anastomosis or ureteroneocystostomy [9,10]. In preparation for surgery, a nephrostomy tube should be placed for palliation of obstructive uropathy [6].…”

“…Intraoperatively, the herniated ureter must be carefully dissected away from the hernia sac and replaced in the retroperitoneal space to prevent ureteral injury. Postoperative ultrasound, CT urogram, or diuretic renogram should be done to ensure patency and proper replacement of the ureter [9,10].…”