Obstructive uropathy secondary to ureteral herniation in a pediatric en bloc renal graft.
Ureteral herniation is a rare entity. We report the first case of extraperitoneal ureteral herniation in a pediatric en bloc renal graft causing obstructive uropathy. A 70-year-old, obese patient with an en bloc renal transplant was found to have ureterohydronephrosis in the right renal graft on magnetic resonance imaging. Nephrostomy with insertion of a double-J catheter confirmed the presence of a ureteral loop within the inguinal tract. Surgery confirmed herniation of the ureter through the internal inguinal ring, crossing over the spermatic cord. We performed release, resection, ureteral reimplantation and hernioplasty. Four months later, renal function was normal and urinary tract dilation had diminished. This case illustrates an unusual cause of obstructive uropathy in a transplanted kidney. Apart from obesity, two other factors may have contributed to its development: presence of a redundant ureter, and the fact that the ureter had been placed over, rather than under, the spermatic cord.
Urology Service, Hopsital and University Complex of Albacete, Faculty of Medicine, University of Castilla-La Mancha, Albacete, Spain. asalinas@pulso.com
Antonio S Salinas
AS
Sánchez
Jesús Cifuentes
JC
Tebar
Miguel Segura
MS
Martín
José M Giménez
JM
Bachs
María J Donate
MJ
Moreno
Héctor Pastor
HP
Navarro
Julio A Virseda
JA
Rodríguez
D000368:Aged; D006552:Hernia, Inguinal / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000601:surgery*; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D011859:Radiography; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery