Ureterosciatic Hernia in Focus: A Narrative Review of the Literature.

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.

Uretero-Sciatic Hernia (Lindbom Hernia): A Case Report and Long-Term Follow-Up.

Ureteric herniation through the posterior pelvic wall is one of the rarest variants of hernias and causes of ureteric obstruction. The clinical features span from asymptomatic to a presentation with severe flank pain and life-threatening infection secondary to ureteric obstruction. The diagnosis needs a high index of suspicion and timely, appropriate radiological investigation. This article presents a case report of a patient who presented with a history of nonspecific abdominal pain and was diagnosed with a left-sided uretero-sciatic hernia (Lindblom hernia). This was managed with routine ureteral stent changes. Long-term follow-up and results from over 10 years of management are presented.

HoLEP for acute and non-neurogenic chronic urinary retention: how effective is it?

PURPOSE: To determine catheter status within 3 months of holmium laser enucleation of the prostate (HoLEP) for acute and non-neurogenic chronic urinary retention (AUR and NNCUR), to compare short-term outcomes of HoLEP for urinary retention (UR) versus lower urinary tract symptoms (LUTS), and to report long-term serum creatinine (SC) after HoLEP for high-pressure chronic urinary retention (HPCUR). METHODS: A prospectively maintained database of the first 500 consecutive HoLEP cases performed under the care of a single surgeon was analysed retrospectively. Urodynamic studies (UDS) did not play a role in the decision making process for those with UR. NNCUR was defined as painless, with post-void residual volume (PVR) greater than 300 ml in men able to void and initial catheter drainage > 1000 ml in men unable to void. RESULTS: 280/500 (56%) were in UR: AUR (195), and NNCUR (85) including 22 with HPCUR. The UR cohort were older with higher enucleated tissue weight [median (IQR); 72 years (66-79 year) and 56 g (29.8-86.3 g)], than the LUTS cohort [70 years (64-75 year) and 38 g (18-67 g)] (p < 0.001). 98.9% with AUR and 98.8% with NNCUR were catheter-free 3 months after HoLEP. There were no significant differences in transfusion rates, hospital stay, or time to first trial without catheter (TWOC) between the LUTS and UR cohorts, nor in international prostate symptom score and quality of life scores, maximum urinary flow rate, post void residual volume or urinary incontinence at 3 months. Patients with NNCUR were less likely to pass their first TWOC (58.8%) than those with AUR (84.6%) or LUTS (87.7%), p < 0.001. None with HPCUR had a clinically significant deterioration in SC at a median of 60 months (IQR 36-82 months). CONCLUSION: HoLEP has 3-month catheter-free rates in excess of 98.5% for AUR and NNCUR in patients not pre-selected by UDS. First TWOC is significantly more likely to fail after HoLEP for NNCUR than AUR or LUTS. HoLEP is a durable treatment for HPCUR and there is no need to monitor renal function to detect recurrence.

A rare case of polyorchidism.

A 28-year-old offshore worker attended accident and emergency department with a tender benign-feeling lump inferior to the left testis. He was previously investigated abroad with an ultrasound scan showing a homogenous mass posterior to the left testis. Subsequent CT was unremarkable. As there was no clinical suspicion of malignancy, a scrotal exploration was performed. During scrotal exploration, the left testicular mass appeared to be a supernumerary testis, which shared the same tunica albuginea. Histology has confirmed the diagnosis. Polyorchidism is an extremely rare congenital anomaly, and can be associated with hydrocele, testicular torsion or rarely malignancy. Leung has classified polyorchidism in four types. This case has been described as type 2; the supernumerary testis shares the epididymis and the vas deferens of the other testis. Treatment can either be conservative or surgical excision. However, if the supernumerary testis is asymptomatic, with negative tumour markers and radiological findings, surgery can be avoided.

Herpes zoster induced acute urinary retention in the immunocompetent female.

We present a rare case of acute urinary retention complicated by constipation secondary to a unilateral herpes zoster reactivation in the S2-4 dermatomes of an immunocompetent female. Diagnosis was confirmed by clinical examination, negative cystoscopy and positive viral polymerase chain reaction (PCR) for herpes zoster virus. The patient was commenced on a course of oral acyclovir, the bowel symptoms resolved, and the patient was discharged with a urinary catheter in situ for an outpatient trial without catheter for 2 weeks to be followed by a course of intermittent self catheterisation pending resolution of symptoms.