Ureterosciatic hernia: An up-to-date overview of evaluation and management

Abstract

Ureterosciatic hernia, defined as a suprapiriform or infrapiriform herniation of the pelvic ureter, is the sliding of the ureters into the pelvic fossa, fovea, or greater or lesser sciatic foramen. This type of hernia is the rarest form of pelvic sciatic hernias. It may cause a wide range of cryptic clinical symptoms of pain, obstructive uropathy, sepsis, or renal failure. This condition has been described in terms of involvement in inguinal, femoral, sciatic, obturator, and thoracic regions. A high index of clinical suspicion is essential for diagnosis because the hernia develops in the pelvic cavity and becomes overlayed by the large gluteal muscle. Since ureterosciatic hernias have not been adequately reviewed in the literature due to the limited number of case reports, we aim to aid the clinician's knowledge by discussing the relevant anatomy, classification, clinical symptoms, optional radiology, optional diagnostic instrumentation, and management. Treatment options include non-surgical and surgical intervention. Vena caval filters may be preoperatively indicated due to the proximity of the pelvic venous vasculature in the surgical field. Treatment must also be mandated for intraoperative and postoperative vascular, neurological, and other anticipated complications of complex ureterosciatic hernia repair. Keywords: Ureter, Sciatic hernia, Ureteral obstruction, Sepsis, Hydronephrosis, Renal failure