[Downloaded free from http://www.urologyannals.com on Monday, January 25, 2021, IP: 158.232.3.16] Case Report Ureteroneocystostomy herniation leading to obstructive uropathy 10 years postrenal transplant: A rare case report Shailesh Chandra Sahay, Dilip Bhalla1, Pawan Kesarwani, Madan Sethi1 Departments of Urology and 1Nephrology, Max Superspeciality Hospital, Patparganj, Delhi, India Abstract Herniation of the urinary bladder is observed in around 1%–4% of cases. Bladder herniation rarely presents with obstructive uropathy; however, bladder herniation carrying ureteroneocystostomy and leading to obstructive uropathy of the graft is even rare. Here, we present a case of a 36-year-old male with deranged renal function test who had undergone renal transplant 10 years back. Computed tomography scan revealed bladder herniation with ureteroneocystostomy and hydronephrosis. He was surgically explored by Gibson incision and ureterolysis, and hernioplasty was performed. Although the cause of herniation was ureteroneocystostomy, it was managed immediately without any need for percutaneous nephrostomy. Keywords: Bladder hernia, transplant kidney, ureteroneocystostomy Address for correspondence: Dr. Shailesh Chandra Sahay, Room No 1029, Department of Urology, Max Superspeciality Hospital, Patparganj, Delhi, India. E‑mail: [email protected] Received: 04.01.2019, Accepted: 04.10.2019, Published: 07.11.2019. INTRODUCTION scan of the lower abdomen revealed hydroureter till its insertion in the bladder with an inguinal hernia and bladder Herniation of the urinary bladder is not rare; however, as its content [Figure 1b]. The urine culture was sterile, and around 1%–4% inguinal hernias may involve urinary the total leukocyte count was 8700 cells/µL. Cystoscopy bladder. Bladder herniation rarely presents with obstructive and exploratory laparotomy were planned. On cystoscopy, uropathy as it is mostly unilateral, and bladder herniation neoureteric orifice was patent, but stenting could not be carrying ureteroneocystostomy leading to obstructive done. Right Gibson incision was given, and bladder was uropathy of the graft is even rarer. Here, we present such seen herniating into the right inguinal canal [Figure 1c]. The a unique case, wherein the graft was salvaged in time. ureter was also being pulled out laterally, hence producing a kink that led to dilatation above this kink. It was an CASE REPORT extraperitoneal sliding type of hernia of the bladder. Ureter and bladder were carefully dissected, and Double‑J (DJ) A 36‑year‑old male presented with loss of appetite and stent was placed through a ureterotomy incision along decreased urine output. He had undergone transplantation with hernioplasty [Figure 1d]. The ureterotomy was of the right kidney 10 years ago [Figure 1a]. Ultrasound closed [Figure 1e]. The kidney function was normalized examination showed hydroureteronephrosis of the in 48 h. The patient had presented with obstructive transplanted kidney. The blood urea was 96 mg/dL, and the uropathy due to ureteric obstruction by a bladder hernia serum creatinine was 3.5 mg/dL. Computed tomography This is an open access journal, and articles are distributed under the terms of the Creative Access this article online Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit Quick Response Code: is given and the new creations are licensed under the identical terms. Website: www.urologyannals.com For reprints contact: [email protected] DOI: How to cite this article: Sahay SC, Bhalla D, Kesarwani P, Sethi M. 10.4103/UA.UA_2_19 Ureteroneocystostomy herniation leading to obstructive uropathy 10 years postrenal transplant: A rare case report. Urol Ann 2020;12:90-1. 90 © 2019 Urology Annals | Published by Wolters Kluwer ‑ Medknow [Downloaded free from http://www.urologyannals.com on Monday, January 25, 2021, IP: 158.232.3.16] Sahay, et al.: Ureteroneocystostomy in post renal transplant doing a PCN and achieved an excellent recovery of the graft immediately by surgical exploration. Early surgical exploration may also help in avoiding future stricture formation in the ureter. CONCLUSION a b c Ureteroneocystostomy herniation leading to obstructive uropathy in a transplanted kidney is a very rare entity. If detected early, surgical correction of a hernia and DJ stenting results in excellent graft recovery. Declaration of patient consent The authors certify that they have obtained appropriate d e patient consent form. In the form, the patient has given his Figure 1: (a) Clinical picture showing inguinal hernia bulge, (b) consent for his images and other clinical information to be computed tomography scan coronal image showing herniated sac reported in the journal. The patient understands that his containing bladder with neoureteric orifice, (c) intraoperative image showing hernia sac in relation to ureter, (d) stent being placed from name and initial will not be published and due efforts will ureterotomy incision, and (e) operative image after Double‑J stenting be made to conceal their identity, but anonymity cannot and ureterotomy closure be guaranteed. and improved immediately after hernioplasty and stenting. Financial support and sponsorship The stent was removed cystoscopically after 6 weeks. Nil. DISCUSSION Conflicts of interest There are no conflicts of interest. 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