Fluorescence-guided laparoscopic repair of ureterosciatic hernia using a self-gripping mesh: a case report

Ureterosciatic hernia is an exceptionally rare pelvic floor hernia that can cause ureteral obstruction, hydronephrosis, and recurrent urinary tract infection, with no established standard surgical strategy. We report a 75-year-old woman with recurrent pyelonephritis who underwent elective laparoscopic repair after infection control. A near-infrared fluorescent ureteral catheter was placed preoperatively to enable real-time ureteral visualization. Using a transperitoneal three-port approach, the herniated ureter was reduced, and the hernia orifice at the infrapiriform foramen (10 × 15 mm) was reinforced with a self-gripping mesh without additional fixation to minimize neurovascular injury. Fluorescence guidance allowed precise ureteral identification despite pelvic adhesions. Operative time was 90 min with minimal blood loss, and the postoperative course was uneventful, with no recurrence at 1-year follow-up. This fluorescence-guided, non-fixating mesh repair represents a feasible and safety-oriented strategy for this rare condition. To our knowledge, this is the first report of this approach for ureterosciatic hernia.