Diagnosis and treatment of kidney graft’s ureteral obstruction secondary to ureteral inguinal hernia
10.3760/cma.j.cn112330-20241005-00434
- VernacularTitle:移植肾输尿管腹股沟疝继发输尿管梗阻的诊治分析
- Author:
Kankan SHUI
1
;
Zhouqi TANG
1
;
Hedong ZHANG
1
;
Tengfang LI
1
;
Yu WANG
1
;
Lei LIU
1
;
Helong DAI
1
;
Longkai PENG
1
Author Information
1. 中南大学湘雅二医院器官移植中心肾脏移植科 湖南省器官移植临床医学研究中心，长沙 410011
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
Ureteral inguinal hernia;
Ureteral obstruction;
Nephrectomy;
Hernia repair;
Ureteral stent
- From:
Chinese Journal of Urology
2025;46(2):129-133
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the diagnosis and treatment experience of kidney graft’s ureteral obstruction secondary to ureteral inguinal hernia.Methods:Clinical data of a patient with kidney graft’s ureteral obstruction secondary to ureteral inguinal hernia in the Second Xiangya Hospital of Central South University in December 2023 was retrospectively analyzed.This was a male patient with 44 years old. Eleven years after kidney transplantation, he was admitted to the hospital because his serum creatinine increased for one day, accompanied by oliguria and edema of both lower limbs. His previous basal creatinine was maintained in the range of 60-70 μmol/L. Physical examination showed a mass of about 4 cm×3 cm in the right groin. The patient complained of anuria lasting for 7 hours on the second day after admission, and the serum creatinine increased to 406 μmol/L. B-ultrasound showed obstruction of the transplanted kidney and ureteral hydrops. Abdominal CT scan suggested that the right inguinal hernia (transplanted kidney ureteral hernia) was suspected.Preoperative diagnosis of ureteral obstruction secondary to inguinal hernia of the transplanted kidney was made. Percutaneous nephrostomy was performed under local anesthesia, and postoperative anti-infection and indwelling catheter treatments were given. The serum creatinine dropped significantly and the inguinal mass disappeared. A follow-up color ultrasound showed that the transplanted kidney ureteral obstruction and hydrops were alleviated than before. The patient was discharged 2 days after the nephrostomy operation. He was recommended to visit the general surgeon for hernia repairment in a timely manner after a stable renal function was achieved. The patient's renal function basically returned to normal during the following 3 weeks after discharge, and no hernia repair was performed. He was then readmitted to the hospital in order to remove the nephrostomy tube. The patient's nephrostomy tube and urinary catheter both drained almost 1000ml every day. After being informed of the risk of recurrence of obstruction among others, the nephrostomy was removed. Oliguria occurred on the day of nephrostomy tube removal, slight swelling and pain in the transplanted kidney area, and recurrence mass in the groin was seen. The color ultrasound showed recurrence of hydroureteral obstruction and hydrops in the transplanted kidney, and a transplanted nephrostomy was performed again along the original stoma. The postoperative recovery was smooth. One week later, a MDT by general surgeons and the urologists were conducted for choices of surgery. Traditional inguinal hernia repair (Bassini method) and double J-tube insertion under flexible ureteroscope were performed. Results After the operation, anti-infection with cefuroxime, immunosuppression, wound dressing change were given among other treatments. The nephrostomy tube and urinary catheter were removed before discharge. The double J-tube was removed 2 months after discharge. The outpatient follow-up was carried out until 9 months after the initial nephrostomy. The follow-up serum creatinine was at 62 umol/L. The color Doppler ultrasound showed only localized fluid accumulation and no recurrence of ureteroinguinal hernia.Conclusions:Ureteral inguinal hernia of the transplanted kidney is rare and can lead to hydroureteral obstruction and renal insufficiency in the transplanted kidney. Abdominal CT examination is the first choice, combined with abdominal physical examination for diagnosis. Nephrostomy is an effective measure to relieve obstruction and promote recovery of renal function. Hernia repair surgery is an effective measure to prevent the recurrence of kidney graft’s ureteral inguinal hernia, and Bassini method hernia repair is a feasible treatment measure.
