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Mustafa M, Pouzi A, Senada P, Suraparaju L, Gupta S. Ureterosciatic Hernia in Focus: A Narrative Review of the Literature. Cureus 2023; 15:e49895. [PMID: 38174201 PMCID: PMC10762697 DOI: 10.7759/cureus.49895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. Historically, most cases have been documented as incidental intraoperative findings. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition, distinguished by its potential to cause life-threatening sepsis or renal failure if not promptly recognized and treated. The diagnostic process remains challenging, attributed partly to the vague initial symptomatology and subtle radiological findings, and second, to the rarity of this condition. This challenge may be further compounded by the lack of a clear description of clinical features and pathways to raise clinician suspicion. In light of these considerations, we conducted this literature review to illuminate this unique cause of obstructive uropathy, aiming to delineate its clinical features and explore common diagnostic and treatment options.
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Affiliation(s)
- Mohamed Mustafa
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Afiq Pouzi
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Peter Senada
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Lokesh Suraparaju
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Suresh Gupta
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
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Kakimoto K, Hikone M, Nagai K, Yamakawa J, Sugiyama K, Hamabe Y. Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review. Int J Emerg Med 2021; 14:67. [PMID: 34742226 PMCID: PMC8572418 DOI: 10.1186/s12245-021-00392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options. CASE PRESENTATION We report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient's hemodynamic status gradually improved. CONCLUSIONS Although ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.
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Affiliation(s)
- Kohei Kakimoto
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Mayu Hikone
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Ko Nagai
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Jun Yamakawa
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
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Rodríguez Cabero M, Arnal Chacón G. Ureteral hernia into the greater sciatic foramen treated by ureteral stent placement. Actas Urol Esp 2021; 45:564-565. [PMID: 34535432 DOI: 10.1016/j.acuroe.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Affiliation(s)
- M Rodríguez Cabero
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - G Arnal Chacón
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Rodríguez Cabero M, Arnal Chacón G. Ureteral hernia into the greater sciatic foramen treated by ureteral stent placement. Actas Urol Esp 2021; 45:S0210-4806(21)00083-8. [PMID: 34127283 DOI: 10.1016/j.acuro.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- M Rodríguez Cabero
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - G Arnal Chacón
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Hong Y, Zhang S, Kong X, Zhang Y, Hong S, Chen Y. Case report of ureter obturator hernia and literature review analysis. BMC Urol 2021; 21:86. [PMID: 34051776 PMCID: PMC8164797 DOI: 10.1186/s12894-021-00851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral obturator hernia is a rare condition, usually found accidentally during imaging examinations, or found during surgery. Ureteral hernia can easily lead to ureteral obstruction and hydronephrosis. Long-term hydronephrosis may lead to kidney damage and infection, and eventually cause kidney failure. As of December 31, 2020, there are only 2 literature reports. CASE PRESENTATION This article reports a 67-year-old female patient with no symptoms. The computed tomography (CT) scan of the urinary system to show the left kidney and ureter had hydrops. The CTU imaging of the urinary tract revealed the left ureter pelvis herniated into the parietal pelvic fascia was accompanied by tortuosity and left hydronephrosis. She underwent laparoscopic abdominal wall hernia repair on April 29, 2020, and she recovered well. CONCLUSIONS Ureteral obturator hernia is an uncommon condition. The clinical symptoms are non-specific, including unclear abdominal pain, until the appearance of obstructive diseases of the urinary tract, such as renal insufficiency, urinary tract infection, kidney stones, and uremia. A comprehensive review of the literature shows that it is difficult to make an accurate diagnosis based on physical examination alone.Early urography can improve the possibility of accurate diagnosis. When a patient suffers from impaired renal function, timely surgical treatment can avoid deterioration of renal function.
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Affiliation(s)
- Yongqiang Hong
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Siyu Zhang
- Department of General Surgery, The First Affiliated Hospital of Xiamen niversity, Xiamen, 361001, China
| | - Xiuying Kong
- Xiamen University School of Medicine, Xiamen, 361001, China
| | - Yuxin Zhang
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Shaokun Hong
- Department of General Surgery, The First Affiliated Hospital of Xiamen niversity, Xiamen, 361001, China
| | - Yuedong Chen
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China. .,Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, 361001, China.
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Rose KM, Carras K, Arora K, Pearson D, Harold K, Tyson M. Robot-assisted repair of ureterosciatic hernia with mesh. J Robot Surg 2019; 14:221-225. [DOI: 10.1007/s11701-019-00969-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
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Kimura J, Yoshikawa K, Sakamoto T, Lefor AK, Kubota T. Successful manual reduction for ureterosciatic hernia: A case report. Int J Surg Case Rep 2019; 57:145-151. [PMID: 30959363 PMCID: PMC6453801 DOI: 10.1016/j.ijscr.2019.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022] Open
Abstract
Manual reduction was successfully performed for a patient with sciatic hernia. There were no report of closed manual reduction previously. A sciatic hernia in women may be manually reduced without surgery.
Introduction Sciatic hernias are the least common type of pelvic floor hernias. The purpose of this study was to present a novel technique for manual reduction and to conduct a systematic review of previous reports of sciatic hernias to characterize them and review the outcomes. Presentation of case An 86-year-old female presented with left-sided lumbar pain. She had a past medical history of rheumatoid arthritis and was treated with prednisolone and methotrexate. Her left abdomen and left lumbar area were tender. An unenhanced abdominal computed tomography scan revealed invagination of the left ureter into the left sciatic foramen and a dilated left proximal ureter and renal pelvis. Ultrasonography showed an invaginated left ureter viewing from the left buttock. She was diagnosed with a sciatic hernia. Ultrasound-guided manual transvaginal reduction was performed. Post-procedure unenhanced abdominal computed tomography scan confirmed reduction of the ureter. After 10-months of follow-up, there is no evidence of recurrence. Discussion Previous reports of patients with sciatic hernia were identified. Clinical data associated with the hernia, reduction technique and clinical outcomes were collected for 72 patients. Open reduction was performed in 24 patients. A ureteral stent was placed in eight patients when the hernia contained the ureter. Four postoperative complications including one death were reported in adults. There were no reports of closed manual reduction. Conclusion A sciatic hernia in women may be manually reduced without surgery. Further reviews of this rare entity are needed to determine the best management strategy.
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Affiliation(s)
- Jiro Kimura
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - Kentaro Yoshikawa
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - Takashi Sakamoto
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | | | - Tadao Kubota
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
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Gandhi J, Lee MY, Joshi G, Smith NL, Ali Khan S. Ureterosciatic hernia: An up-to-date overview of evaluation and management. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Nakazawa Y, Morita N, Chikazawa I, Miyazawa K. Ureterosciatic hernia treated with ureteral stent placement. BMJ Case Rep 2018; 2018:bcr-2017-222908. [PMID: 29728432 PMCID: PMC5935149 DOI: 10.1136/bcr-2017-222908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 92-year-old female with a history of asthma and chronic heart failure presented with left lumber back pain. Physical examination revealed knocking tenderness at the left costal-vertebral angle. Laboratory test results were within normal limits. Abdominal CT showed a left hydroureteronephrosis and an obstruction in the left distal ureter with herniation into the sciatic foramen. A ureteral stent was inserted into the left ureter and was removed after 2 months. She has not complained of pain or showed symptoms since the removal. Our case suggests that doctors consider the possibility of ureterosciatic hernias when examining older patients complaining of lower back pain.
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Affiliation(s)
| | - Nobuyo Morita
- Urology, Kanazawa Medical University, Kahoku-gun, Japan
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Lin FC, Lin JS, Kim S, Walker JR. A rare diaphragmatic ureteral herniation case report: endoscopic and open reconstructive management. BMC Urol 2017; 17:26. [PMID: 28381270 PMCID: PMC5381035 DOI: 10.1186/s12894-017-0207-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral herniations are a rare occurrence, generally found incidentally on cross sectional imaging or during surgical intervention for unrelated processes. Several locations of ureteral herniations can occur including the inguinal, femoral, sciatic, obturator, and thoracic regions. While few reports of ureteral hernias are reported in the literature overall, the vast majority of those reported are inguinoscrotal herniations found during evaluation and treatment of inguinal hernias. Pelvic outlet ureteral herniations intrinsically are more common secondary to their dependent locations. Intrathoracic ureteral herniations through diaphragmatic defects are an exceptionally rare subset of ureteral herniations and have only been described sparingly. Fewer than ten case reports of diaphramatic ureteral herniations have been reported and none have described both cystoscopic management and open reconstruction. CASE PRESENTATION We report the case of a 81 year old female with flank pain who was found to have idiopathic diaphragmatic hernia with incarcerated proximal ureter. She had no prior injury or surgery that explained her clinical presentation. She was initially observed and then managed conservatively with ureteral stent exchanges. Ultimately she underwent open surgical repair of her diaphragmatic hernia, reduction, resection and anastomosis of redundant proximal incarcerated ureteral segment, and nephropexy for a hypermobile right renal unit. This case report illustrates the pre- and post-operative imaging studies of a very rare intrathoracic ureteral herniation as well as surgical approach to repair. CONCLUSION A herniated ureter is a potential source of serious renal and ureteral complications. The thoracic herniation of ureter is the rarest of the ureteral herniations. When discovered, they should be managed to preserve renal function and prevent strangulation of the affected segment of ureter. This case report documents the treatment of a thoracic ureteral herniation with observation, conservative endoscopic management, and finally open surgical reconstruction.
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Affiliation(s)
- Frank C Lin
- Division of Urology, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA.
| | - Jamie S Lin
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, 3400 Civic Blvd, Philadelphia, PA, 19104, USA
| | - Samuel Kim
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - Jonathan R Walker
- Division of Urology, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA
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