Mesh plug and ureteral necrosis after kidney transplantation

CASE REPORT: We present a 59-year-old male who underwent living related kidney transplantation. During the procedure a previously placed mesh plug was found to be adherent to structures in the vicinity of the area of implantation. After revascularization, neocystouretostomy was performed with the ureter over the spermatic cord in order to avoid excessive dissection through this adherent mass. Shortly thereafter the patient was diagnosed with a ureteral leak and returned to the operating room. The intraoperative findings included adhesion of the ureter to the mesh plug with necrosis of its distal portion. A redo neocystouretostomy was performed. The patient recovered uneventfully. CONCLUSION: This case report illustrates a unique cause of a urinary fistula related to mesh plug open inguinal hernia repair and demonstrates the importance of ensuring a safe distance between vital structures and any prosthetic device.