Obstructive uropathy secondary to ureteral inguinoscrotal hernia

Management of an obstructing calculus in an anticoagulated patient with a ureteral hernia

“…Ureteral hernias occur as one of two anatomical variants: paraperitoneal or extraperitoneal. 10 , 11 , 12 , 13 Paraperitoneal hernias are more common, thought to occur in approximately 80 % of cases, where the ureter is pulled alongside the peritoneal sac and forms part of the hernia wall due to adhesions of the ureter to the posterior peritoneum. In this case, the ureter is most often noted medial to the peritoneal sac.…”

“… 13 The extraperitoneal variety, is theorized to be a result of a congenital embryonic defect. 5 , 11 The ureteral hernia develops without involving the peritoneal sac, but rather as a prolapse of retroperitoneal structures likely due to fusion of the ureter and genitoinguinal ligaments because of failed ureteric bud separation from the Wolffian duct. 5 , 11 This was previously reported to account for 20 % of ureteroinguinal hernias, but many recent case reports describe this occurrence, whether due to prevalence or publication bias.…”

“…An entangled ureter within an inguinal hernia might be suspected preoperatively, if the patient presents with signs and symptoms of urinary obstruction or renal failure. 1 , 6 , 7 , 10 , 11 , 12 , 13 , 14 However, many are discovered incidentally and intraoperatively; lack of awareness of ureteral involvement prior to hernia repair poses a risk of inadvertent damage, which may lead to long-term renal consequences. 15 Identifying ureteral involvement in an inguinal hernia prior to herniorrhaphy is difficult.…”