Ureteral herniation with intermittent obstructive uropathy in a renal allograft recipient.

A 44-year-old man underwent live related allograft renal transplantation for stage V chronic kidney disease secondary to unknown cause three years earlier. The immunosuppressive regimen consisted of cyclosporine, azathioprine, and prednisolone. The nadir creatinine level of 1.5 mg/dL was reached one week postoperatively. This remained stable for 30 months when the serum level of creatinine began to fluctuate intermittently between 1.5 mg/dL and 2.2 mg/dL. He noticed a reducible swelling in the lower third of the transplant scar that was confirmed to be an incisional hernia. Ultrasonography showed graft hydroureteronephrosis. Magnetic resonance urography revealed an incisional hernia involving the lower third of the transplant scar, containing the mid-portion of the transplant ureter and compressing the distal ureter at the neck of the hernial sac, causing hydroureteronephrosis.