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Inguinoscrotal Hernia of the Ureter Combined With Renal Pelvic Carcinoma
Images in Clinical Urology Inguinoscrotal Hernia of the Ureter Combined With Renal Pelvic Carcinoma Fu-Qing Tan, Kai Yang, Jian-Hong Zheng, Shan-Wen Chen, and Li-Ping Xie Inguinoscrotal herniation of the ureter is a rare finding, with the potential for serious surgical complications. Here we report an extremely rare case of inguinoscrotal hernia of the ureter combined with renal pelvic carcinoma. This 61-year-old man was diagnosed with right renal pelvic tumor, bilateral hydronephrosis with inguinoscrotal hernia of the right ureter, and left ureteral calculus. He was successfully treated with right nephroureterectomy, inguinoscrotal hernia repair, and left ureterolithotomy. Pathologic examinations revealed a high-grade transitional cell carcinoma. UROLOGY 82: e5ee6, 2013. 2013 Elsevier Inc.
Figure 1. Computed tomography shows the presence of the (A, D) tumor of the right renal pelvis (arrow), (B, D) inguinoscrotal herniation of the right ureter (arrow), and a (C) calculus in the lower part of the left ureter (arrow).
Financial Disclosure: The authors declare that they have no relevant financial interests. Funding Support: This study was supported by grants from the National Natural Science Foundation of China (Grant No. 81101718) and the National Key Clinical Specialty Construction Project of China. From the Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China Reprint requests: Kai Yang, M.D., Ph.D., Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Rd 79, Hangzhou 310003, China. E-mail: [email protected] Submitted: March 4, 2013, accepted (with revisions): April 12, 2013
ª 2013 Elsevier Inc. All Rights Reserved
A
61-year-old Chinese man was admitted to our hospital with complaint of gross hematuria for 1 month. Abdominal ultrasonography revealed a 5.0 3.5 cm mass located in the right renal pelvis with bilateral hydronephrosis. The serum creatinine was 110 mmoI/L. Subsequent computed tomography (CT) demonstrated not only the right renal pelvic tumor but also, coincidently, inguinoscrotal herniation of the right ureter and a calculus in the left ureter (Fig. 1). 0090-4295/13/$36.00 http://dx.doi.org/10.1016/j.urology.2013.04.020
e5
Figure 2. Three-dimensional reconstruction of the left ureter (B, C) based on the contrast-enhanced computed tomography images (A).
Figure 3. Three-dimensional reconstruction of the right ureter (B, C) based on the contrast-enhanced computed tomography images (A).
Three-dimensional reconstruction of the contrastenhanced CT images was performed (Figs. 2 and 3). Right nephroureterectomy, inguinoscrotal hernia repair, and left ureterolithotomy were performed. Postoperative serum creatinine ranged from 105-120 mmoI/L. Subsequent pathologic diagnosis was high-grade transitional cell carcinoma of the right renal pelvis. The patient was followed up, and no sign of recurrence was observed for 8 months so far. Ureteral herniation is a rare phenomenon that is divided into 2 subgroups: paraperitoneal (with a peritoneal hernial sac) and extraperitoneal (without a hernial sac).1-7 Our report describes the paraperitoneal type with a peritoneal hernia sac containing greater omentum. To our knowledge, this seems to be the first documentation of a patient having both inguinoscrotal hernia of the ureter and renal pelvic carcinoma.
e6
References 1. Mallouh C, Pellman CM. Scrotal herniation of the ureter. J Urol. 1971;106:38-41. 2. Giglio M, Medica M, Germinale F, et al. Scrotal extraperitoneal hernia of the ureter: case report and literature review. Urol Int. 2001; 66:166-168. 3. Giuly J, Franc¸ois GF, Giuly D, et al. Intrascrotal hernia of the ureter and fatty hernia. Hernia. 2003;7:47-49. 4. Bertolaccini L, Giacomelli G, Bozzo RE, et al. Inguino-scrotal hernia of a double district ureter: case report and literature review. Hernia. 2005;9:291-293. 5. Akpinar E, Turkbey B, Ozcan O, et al. Bilateral scrotal extraperitoneal herniation of ureters: computed tomography urographic findings and review of the literature. J Comput Assist Tomogr. 2005; 29:790-792. 6. Sharma RK, Murari K, Kumar V, et al. Inguinoscrotal extraperitoneal herniation of a ureter. Can J Surg. 2009;52:E29-E30. 7. Golgor E, Stroszczynski C, Froehner M. Extraperitoneal inguinoscrotal herniation of the ureter: a rare case of recurrence after hernia repair. Urol Int. 2009;83:113-115.
UROLOGY 82 (1), 2013
Figure 1. Computed tomography shows the presence of the (A, D) tumor of the right renal pelvis (arrow), (B, D) inguinoscrotal herniation of the right ureter (arrow), and a (C) calculus in the lower part of the left ureter (arrow).
Financial Disclosure: The authors declare that they have no relevant financial interests. Funding Support: This study was supported by grants from the National Natural Science Foundation of China (Grant No. 81101718) and the National Key Clinical Specialty Construction Project of China. From the Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China Reprint requests: Kai Yang, M.D., Ph.D., Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Rd 79, Hangzhou 310003, China. E-mail: [email protected] Submitted: March 4, 2013, accepted (with revisions): April 12, 2013
ª 2013 Elsevier Inc. All Rights Reserved
A
61-year-old Chinese man was admitted to our hospital with complaint of gross hematuria for 1 month. Abdominal ultrasonography revealed a 5.0 3.5 cm mass located in the right renal pelvis with bilateral hydronephrosis. The serum creatinine was 110 mmoI/L. Subsequent computed tomography (CT) demonstrated not only the right renal pelvic tumor but also, coincidently, inguinoscrotal herniation of the right ureter and a calculus in the left ureter (Fig. 1). 0090-4295/13/$36.00 http://dx.doi.org/10.1016/j.urology.2013.04.020
e5
Figure 2. Three-dimensional reconstruction of the left ureter (B, C) based on the contrast-enhanced computed tomography images (A).
Figure 3. Three-dimensional reconstruction of the right ureter (B, C) based on the contrast-enhanced computed tomography images (A).
Three-dimensional reconstruction of the contrastenhanced CT images was performed (Figs. 2 and 3). Right nephroureterectomy, inguinoscrotal hernia repair, and left ureterolithotomy were performed. Postoperative serum creatinine ranged from 105-120 mmoI/L. Subsequent pathologic diagnosis was high-grade transitional cell carcinoma of the right renal pelvis. The patient was followed up, and no sign of recurrence was observed for 8 months so far. Ureteral herniation is a rare phenomenon that is divided into 2 subgroups: paraperitoneal (with a peritoneal hernial sac) and extraperitoneal (without a hernial sac).1-7 Our report describes the paraperitoneal type with a peritoneal hernia sac containing greater omentum. To our knowledge, this seems to be the first documentation of a patient having both inguinoscrotal hernia of the ureter and renal pelvic carcinoma.
e6
References 1. Mallouh C, Pellman CM. Scrotal herniation of the ureter. J Urol. 1971;106:38-41. 2. Giglio M, Medica M, Germinale F, et al. Scrotal extraperitoneal hernia of the ureter: case report and literature review. Urol Int. 2001; 66:166-168. 3. Giuly J, Franc¸ois GF, Giuly D, et al. Intrascrotal hernia of the ureter and fatty hernia. Hernia. 2003;7:47-49. 4. Bertolaccini L, Giacomelli G, Bozzo RE, et al. Inguino-scrotal hernia of a double district ureter: case report and literature review. Hernia. 2005;9:291-293. 5. Akpinar E, Turkbey B, Ozcan O, et al. Bilateral scrotal extraperitoneal herniation of ureters: computed tomography urographic findings and review of the literature. J Comput Assist Tomogr. 2005; 29:790-792. 6. Sharma RK, Murari K, Kumar V, et al. Inguinoscrotal extraperitoneal herniation of a ureter. Can J Surg. 2009;52:E29-E30. 7. Golgor E, Stroszczynski C, Froehner M. Extraperitoneal inguinoscrotal herniation of the ureter: a rare case of recurrence after hernia repair. Urol Int. 2009;83:113-115.
UROLOGY 82 (1), 2013