A Rare Case of Obstructive Uropathy in Renal Transplantation: Ipsilateral Indirect Inguinal Herniation of a Transplant Ureter

Azhar, Raed A.; Boutros, Marylise; Hassanain, Mazen; Polyhronopoulos, Gerry N.; Chaudhury, Prosanto; Cabrera, Tatiana

doi:10.1097/tp.0b013e3181b9e28d

Cited by 22 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Discussionmentioning

confidence: 81%

“…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.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Bugeja

Clark

Sood

et al. 2018

Can J Kidney Health Dis

View full text Add to dashboard Cite

Background:Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss.Case Presentation:We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair.Conclusions:Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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

Bugeja

Clark

Sood

et al. 2018

Can J Kidney Health Dis

View full text Add to dashboard Cite

show abstract

“…7–19 Factors that may contribute to inguinal herniation of the transplant kidney include the existence of a redundant long ureter, placement of donor ureter over the spermatic cord, obesity, and stricture of the ureterovesicular anastomosis leading to twisting and kinking of the ureter into the inguinal canal. 7,11,17,19 Older male patients, with a median age of 56.9 years, were more commonly affected. Inguinal herniation of the ureter is a late cause of obstructive uropathy and presented at a mean of 10.6 years (range 2–20, years) after transplantation.…”

Section: Discussionmentioning

confidence: 99%

First Case Report of Acute Renal Failure After Mesh-Plug Inguinal Hernia Repair in a Kidney Transplant Recipient

Veroux¹,

Ardita

Zerbo³

et al. 2016

Medicine

View full text Add to dashboard Cite

Acute renal failure due to ureter compression after a mesh-plug inguinal repair in a kidney transplant recipient has not been previously reported to our knowledge. A 62-year-old man, who successfully underwent kidney transplantation from a deceased donor 6 years earlier, was admitted for elective repair of a direct inguinal hernia. The patient underwent an open mesh-plug repair of the inguinal hernia with placement of a plug in the preperitoneal space. We did not observe the transplanted ureter and bladder during dissection of the inguinal canal. Immediately after surgery, the patient became anuric, and a graft sonography demonstrated massive hydronephrosis. The serum creatinine level increased rapidly, and the patient underwent an emergency reoperation 8 hours later. During surgery, we did not identify the ureter but, immediately after plug removal, urine output increased progressively. We completed the hernia repair using the standard technique, without plug interposition, and the postoperative course was uneventful with complete resolution of graft dysfunction 3 days later.Furthermore, we reviewed the clinical features of complications related to inguinal hernia surgery. An increased risk of urological complications was reported recently in patients with a previous prosthetic hernia repair undergoing kidney transplantation, mainly due to the mesh adhesion to surrounding structures, making the extraperitoneal dissection during the transplant surgery very challenging. Moreover, older male kidney transplant recipients undergoing an inguinal hernia repair may be at higher risk of graft dysfunction due to inguinal herniation of a transplanted ureter.Mesh-plug inguinal hernia repair is a safe surgical technique, but this unique case suggests that kidney transplant recipients with inguinal hernia may be at higher risk of serious urological complications. Surgeons must be aware of the graft and ureter position before proceeding with hernia repair. A prompt diagnosis with graft sonography and abdominal computed tomography scan and emergency surgery may avoid the need for nephrostomy and may resolve graft dysfunction more rapidly.

show abstract

“…To our knowledge, primary and secondary abdominal hernia of the kidney is scarce and has been very rarely reported [1,2,3,4,5,6]. Reports in the literature include inguinal-scrotal hernias containing ureter and bladder with post-renal failure [2,3] or containing ectopic pelvic kidney [1,4,5] that are mostly related with congenital ectopic supernumerary and pelvic kidneys with congenital or acquired hernia as well as after iliac kidney transplantation with predisposing or incisional hernia orifices [5,6,7]. Only one case of a pelvic, symptomatic kidney located in a large inguinal hernia has been published, however without an intestinal hernia and with hydronephrosis due to ureter restriction at the hernia orifice [1].…”

Section: Discussionmentioning

confidence: 99%

Kidney Dislocation in a Monstrous Inguinal Intestinal Hernia with Ureteropelvic Junction Obstruction and Acute on Chronic Renal Failure

et al. 2013

View full text Add to dashboard Cite

Introduction: Inguinal hernias are the most common hernias in adult males. Abnormalities should be taken into account for therapeutic procedures. This is the first report of a dislocation of a primary orthotopic kidney in a monstrous inguinal intestinal hernia. Case Presentation: This paper reports an incidental finding of a dislocation of a primary orthotopic kidney in a monstrous inguinal intestinal hernia of an 82-year-old patient with intracranial injury and acute kidney failure. Post-renal kidney failure could be excluded by ultrasound and CT examination. The acute renal decompensation resulted from rhabdomyolysis associated with a falling down trauma with crush syndrome and pneumonic septicaemia based on chronic renal failure associated with nephrosclerosis and ureteropelvic junction obstruction conditioned atrophic right kidney. Conclusion: Previous reports in the literature include inguinal-scrotal hernias containing ureter and bladder with post-renal failure or containing ectopic congenital pelvic or transplanted iliac kidney. Our patient is very unusual in that he presented with inguinal herniated, orthotopic, atrophic hydronephrosis with suspicion of congenital ureteropelvic junction obstruction as well as an asymptomatic large intestinal hernia. Reasons for pre-renal acute on chronic renal failure can make it difficult to arrive at a decision of a urological therapy.

show abstract

A Rare Case of Obstructive Uropathy in Renal Transplantation: Ipsilateral Indirect Inguinal Herniation of a Transplant Ureter

Cited by 22 publications

References 18 publications

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

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

First Case Report of Acute Renal Failure After Mesh-Plug Inguinal Hernia Repair in a Kidney Transplant Recipient

Kidney Dislocation in a Monstrous Inguinal Intestinal Hernia with Ureteropelvic Junction Obstruction and Acute on Chronic Renal Failure

Contact Info

Product

Resources

About