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Indirect inguinal hernia in CAPD patients with polycystic kidney disease
Insights
Male patients with autosomal dominant polycystic kidney disease (PKD) on continuous ambulatory peritoneal dialysis (CAPD) have a high incidence of indirect inguinal hernias. Routine screening and repair of patent processus vaginalis are recommended before or during CAPD catheter insertion.
Area of Science:
- Nephrology
- Surgical Urology
- Medical Diagnostics
Background:
- Autosomal dominant polycystic kidney disease (PKD) is a genetic disorder affecting the kidneys.
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for kidney failure.
- Indirect inguinal hernias are a common surgical condition.
Purpose of the Study:
- To investigate the incidence of indirect inguinal hernias in male patients with PKD undergoing CAPD.
- To determine the association between PKD, CAPD, and the development of indirect inguinal hernias.
- To evaluate the prevalence of patent processus vaginalis in this patient group.
Main Methods:
- Retrospective analysis of male patients with PKD on CAPD.
- Comparison with male patients on CAPD without PKD and male patients with PKD on hemodialysis or conservative treatment.
- Clinical examination and peritoneogram with 99m Tc sulfur colloid in one case.
Main Results:
- A significantly higher incidence of indirect inguinal hernias (46.2%) was observed in male PKD patients on CAPD compared to other male CAPD patients (3.3%).
- 29.4% of male PKD patients on hemodialysis or conservative treatment had a history or evidence of inguinal hernia.
- A patent processus vaginalis was suspected in one patient who subsequently developed an indirect inguinal hernia.
Conclusions:
- There is a high association between autosomal dominant polycystic kidney disease and the development of indirect inguinal hernias in patients undergoing CAPD.
- Routine screening for patent processus vaginalis is recommended in male PKD patients prior to or during CAPD catheter insertion.
- Surgical repair of patent processus vaginalis may prevent the occurrence of indirect inguinal hernias in this high-risk population.
Abstract:
We have experienced a high incidence of indirect inguinal hernias occurring in the first few months of starting CAPD in male patients with autosomal dominant polycystic kidney disease (PKD). Out of 13 patients with P.C.K. on CAPD one (7.7%) had inguinal herniorraphy at an early age and six (46.2%) developed bilateral indirect inguinal hernia during CAPD. In comparison only one of 30 other male patients on CAPD developed indirect inguinal hernia and none had any evidence of previous inguinal herniorrhaphy or of indirect inguinal hernia on clinical examination. Five out of seventeen (29.4%) male patients with P.C.K. on hemodialysis or conservative treatment of renal impairment had history of inguinal herniorrhaphy or an evidence of inguinal hernia on clinical examination. This compares with a rate of herniorrhaphy performed for indirect inguinal hernia approximately 1.5 per 1000 population. In one patient on CAPD a peritoneogram using 99m Tc sulfur colloid suggested a patent processes vaginalis to account for scrotal edema on one side; the patient subsequently developed an indirect inguinal hernia on the other side just a few months after the repair. In view of high association of patent processus vaginalis with P.C.K. we recommend it is routinely searched in this group of patients and repaired at time of CAPD catheter insertion.