Robotic-Assisted Repair of a Ureterosciatic Hernia with Combined Ureteral Stenting.

Abstract

Pelvic floor hernias represent a rare type of hernia and a rare etiology of pelvic symptoms. The rarest type of pelvic floor hernias are sciatic hernias, which present with a variety of symptoms depending on the hernia contents and location. Many different treatment approaches are described in the literature. A 73-year-old female presented to our outpatient minimally invasive surgery (MIS) clinic with one year of colicky left flank pain. She had previously presented to an emergency department, at which time a computed tomography (CT) scan demonstrated left-sided hydronephrosis in the setting of a left-sided ureterosciatic hernia. She was asymptomatic and had no palpable hernia bulge. An operative repair was offered based on her prolonged symptoms. The patient was brought electively to the operating room with minimally invasive and urological surgeons. A left ureteral stent was placed over a guidewire. A robotic repair was performed with a round piece of biosynthetic mesh, secured in place with fibrin glue. Sciatic hernias are an extremely rare etiology of pelvic symptoms and require a high index of suspicion to identify. Obstructive and neuropathic symptoms may be intermittent, so diagnosis is often made using CT imaging. We report a successful treatment with pre-operative ureteral stenting followed by a robotic repair using biologic mesh secured with fibrin glue fixation. We believe this is a durable repair although acknowledge that longer follow-up is needed to establish the longevity of our treatment modality.