Case reportInguinal Herniation of a Transplant Ureter: Rare Cause of Obstructive Uropathy
Section snippets
Case Presentation and Management
A 72-year-old man presented in acute renal failure 12 years after receiving a renal transplant from his brother. He complained of shortness of breath and weakness over a 3-day period. He noted decreased urine output throughout this time. The patient had been seen 2 months before presentation and was noted to be in good health with stable renal function. Physical examination revealed an obese man with a small nonreducible left inguinal hernia. His creatinine was elevated to 2.4 mg/dL from a
Discussion
Most cases of late ureteral obstruction after renal transplantation result from obstruction in the lower ureter or ureterovesical junction.1, 4, 10, 11 More often, these are caused by ureterovesical junction obstruction or ischemia of the lower ureter. These patients often present several months to years after surgery. To our knowledge, transplant ureteral obstruction secondary to incarceration within an inguinal hernia is an extremely rare entity, described in the literature twice.8, 12
Our
References (13)
- et al.
Urological complications in 1000 consecutive renal transplant recipients
J Urol
(1995) - et al.
Ureteral stenosis after kidney transplantation: true incidence and long term follow-up after surgical correction
J Urol
(1985) - et al.
Prolonged ureteral stenting in obstruction after renal transplantation: long-term results
Transplant Proc
(2004) - et al.
Obturator herniation of the ureter in a renal transplant recipient causing hydronephrosis: perioperative percutaneous management
J Vasc Interv Radiol
(1996) - et al.
Obstructive uropathy secondary to ureteral herniation in a pediatric en bloc renal graft
Am J Transplant
(2005) - et al.
The surgical complications of renal transplantation
Urol Clin N Am
(1979)
Cited by (28)
Not as Rare as Initially Described: Transplant Ureter Incarceration Within Inguinal Hernia. Two Cases, Literature Review, and Management Algorithm
2021, Transplantation ProceedingsCitation Excerpt :The first report of true ureter herniation into the inguinal hernia was by Osman et al [8]. Notably, nearly all subsequent reports continue to refer to the condition as rare [5,9-20]. The majority of case reports describe acute kidney injury as the primary presentation, with decompressive percutaneous nephrostomy tube being the most widely adopted to manage the acute presentation.
A Management of Ureteral Obstruction After Lichtenstein Tension-Free Hernia Repair in a Kidney Transplant Recipient: A Case Report
2021, Transplantation ProceedingsCitation Excerpt :In many reports, the most used imaging technique was abdominal US for work-up of complications after inguinal hernia repairs, whereas computed tomography and magnetic resonance imaging were also used in some patients. PNCs were placed preoperatively in many patients [8,9,14-20]. Determining possible ureteronephrosis preoperatively may facilitate postoperative management of complications in these cases.
Rapidly Progressive Invasive Urothelial Carcinoma With Flat and Infiltrative Growth Pattern in the Graft Kidney After Living-Related Kidney Transplantation: A Case Report
2020, Transplantation ProceedingsCitation Excerpt :Furthermore, the fact that the patient underwent laparoscopy for a right inguinal hernia by the total extraperitoneal repair method also caused difficulty in the diagnosis of UC obstruction. The graft ureter and the internal inguinal ring were structurally close, and many studies have reported that patients who undergo kidney transplants have graft ureter obstructions due to an inguinal hernia [18–20]. We theorized that the transplant and mesh fixation from the total extraperitoneal repair method were in the same space and could have caused the graft ureter obstruction.
Inguinal Bladder Hernia With Acute Ureteral Obstruction 14 Years After Kidney Transplantation: A Case Report
2017, Transplantation ProceedingsManagement of Spermatic Cord Liposarcoma in Renal Transplant Recipients: Case Report
2010, Transplantation ProceedingsCitation Excerpt :The peculiar therapeutic implications are as follows. First, the preoperative diagnosis was inguinal hernia, and in renal transplant recipients, the presence of a herniated ureter is not uncommon.20,21 Both conditions require immediate repair to avert obstructive uropathy.22–24
Scrotal Herniation of the Ureter: A Rare Late Complication After Renal Transplantation
2009, Transplantation ProceedingsCitation Excerpt :Five of them were the primary type,9–13 whereas one presented as a mixed type,8 where the obstructive uropathy was exacerbated by the herniation into the inguinal canal of the ureter, which became tortuous with kinking following a longstanding stricture at the UVJ. Obesity, previous abdominal wall operations positioning of the ureter above the spermatic cord, and excessive length of the ureter at the time of urinary tract construction are considered to be predisposing factors for herniation.8,11–13 Overall, the mean age at diagnosis is 60.6 years, the mean delay of appearance postoperatively is 9.7 years, and the more frequent localization is in the right inguinal canal.