Uretero-Inguinal Hernia |
| Uretero-inguinal
hernia (UIH) is an exceedingly rare condition, characterized by the
displacement of the ureter into the inguinal canal. This phenomenon can
be congenital or acquired and is often associated with complex
anatomical anomalies or predisposing factors. It poses diagnostic and
therapeutic challenges due to its unusual presentation and the
potential for severe complications if not identified and managed
appropriately. UIH has two primary classifications: paraperitoneal and extraperitoneal. Paraperitoneal UIH, which constitutes approximately 80% of cases, involves the ureter adhering to a hernial sac and being pulled into the inguinal canal. This type is often linked to sliding hernias and may involve other abdominal viscera. In contrast, extraperitoneal UIH, accounting for the remaining 20%, occurs without a hernial sac and is typically associated with congenital anomalies of the ureteral and renal systems. This variety is believed to result from abnormal embryological development, such as late separation of the Wolffian duct or adherence of the ureter to genitoinguinal structures. UIH predominantly affects males, possibly due to the developmental descent of the Wolffian duct structures into the scrotum, creating a pathway for ureteral involvement. In adults, risk factors include advanced age, obesity, renal transplantation, and collagen disorders. In children, the condition is exceptionally rare, with only a limited number of documented cases. Clinical manifestations of UIH are varied and depend on the extent of ureteral involvement and the presence of secondary complications. Patients may present with symptoms ranging from an asymptomatic inguinal mass to signs of obstructive uropathy, such as flank pain, hematuria, or hydronephrosis. In many cases, UIH is discovered incidentally during surgical exploration for inguinal hernia repair. Imaging modalities like ultrasound, computed tomography (CT), and voiding cystourethrography (VCUG) play critical roles in preoperative diagnosis, helping identify ureteral involvement and associated urinary tract anomalies. Management of UIH requires careful surgical intervention to prevent iatrogenic injuries. The approach varies depending on the type and severity of the hernia, as well as the patient?s overall condition. For paraperitoneal UIH, high ligation of the hernial sac and repositioning of the ureter are common strategies. For extraperitoneal cases, interventions may include ureteral reimplantation or ureteroneocystostomy, especially in the presence of significant obstruction or stricture. In pediatric cases, the rarity of UIH necessitates heightened clinical awareness, particularly in the presence of congenital urological anomalies. Early recognition and intervention are essential to avoid complications like ureteral injury or progressive renal impairment. Long-term follow-up with renal function tests and imaging is crucial to monitor outcomes and prevent recurrence. The literature highlights the importance of individualized care and the role of multidisciplinary teams, including pediatric surgeons, urologists, and radiologists, in managing this complex condition. Advances in laparoscopic techniques have improved visualization and allowed for more precise interventions, reducing morbidity, and enhancing recovery. UIH represents a fascinating interplay between congenital and acquired factors, with implications for both surgical practice and urological management. Continued documentation of cases and research into the underlying mechanisms will be essential to refine diagnostic and therapeutic strategies for this rare entity. References: 1- Handu AT, Garge S, Peters NJ, Kanojia RP, Rao KL: Undiagnosed ureteroinguinal hernia with solitary kidney in a child with ureteric injury during herniotomy. J Pediatr Surg. 47(4):799-802, 2012 2- Lakshmi Narayanan P, C D N, Sekar V, Vadyala AR: Laparoscopic approach to ureteroinguinal hernia. Int J Surg Case Rep. 77:161-164, 2020 3- Turner A, Subramanian P. Ureteroinguinal Hernia: A Rare General Surgery Phenomenon. Cureus. 13(12):e20586, 2021 4- Cianci MC, Tocchioni F, Mantovani A, Ghionzoli M, Morini F: Unexpected Pediatric Uretero-Inguinal Hernia: Case-Report and Literature Review. Urology. 2023 Jun;176:178-182, 2023 5- Delgado-Miguel C, Mu¤oz-Serrano AJ, Aguado P, Fuentes E, D¡ez R: Ureteroinguinal Herniation with Consecutive Ureteral Stricture in a 2-Month-Old Infant: Case Report. European J Pediatr Surg Rep. 12(1):e16-e19, 2024 6-Ger‡el G: A surprise during hernia surgery: inguinoscrotal megaureter. Turk J Pediatr. 66(3):378-382, 2024 |
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