Scrotum Nephroptosis Associated With a Bilateral Inguinoscrotal Hernia in an Orthopedic Patient with Bilateral Knee Osteoarthritis - A Multidisciplinary Case Report Proving the Different Biomaterials Used on the Same Patient

Sebastian Gradinaru ^1,2, Alexandra-Ana Mihailescu ³, George Viscopoleanu ⁵, Cristian Scheau ^4,6, Bogdan-Sorin Capitanu ^4,5 and Serban Dragosloveanu ^4,5

¹ Faculty of Medicine, “Titu Maiorescu” University, 040441 Bucharest, Romania;

² Department of General Surgery, “Ilfov” County Emergency Clinical Hospital, 022104 Bucharest, Romania;

³ Department of Anesthesiology and Critical Care, “Foisor” Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, 021382 Bucharest, Romania;

⁴ “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;

⁵ Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania;

⁶ Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania.

Introduction: Nephroptosis, also known as “floating” kidney, is defined as a pathological descent of the kidney greater than 5 cm or more than two vertebral bodies when changing from the supine to the upright position.

Case report: This case involves a 75-year-old Caucasian man who presented to an orthopedic hospital with advanced bilateral knee osteoarthritis and was scheduled for a right total knee arthroplasty. His medical history was notable for arterial hypertension, type II diabetes mellitus, class I obesity, Parkinson’s disease, and a recently done left knee arthroplasty.

These findings demonstrated that the progressive enlargement of the scrotum was caused by a massive inguinoscrotal hernia containing the right kidney and ureter and all retroperitoneal fat surrounding the kidney, associated with nephroptosis and secondary ureterohydronephrosis. Given the risk of further renal compromise and the unusual anatomical displacement, surgical management was indicated. The surgical team decided to proceed with surgical management consisting of laparoscopic nephropexy combined with repair of the inguinoscrotal hernia.The right kidney was wrapped in a biological acellular dermal matrix (ADM) and secured posteriorly to the psoas muscle using tacks. The membrane was sutured anteriorly over the kidney, leaving space for the ureter and renal pedicle, which assumed a horizontal orientation. After repositioning the kidney in its anatomical location and completing the retroperitoneal and preperitoneal dissection in the inguinal region, a 3D Max XL polypropylene mesh was placed and fixed with absorbable and non-absorbable tacks using a technique similar to the TAPP (transabdominal preperitoneal) hernia repair. The hernia sac and retroperitoneal fat contained within it were transected and left in situ to be removed through a subsequent inguinoscrotal approach. 

Conclusion: At approximately six months of follow-up, the patient demonstrated a favorable clinical evolution, with no reported complaints or complications related to the surgical procedure. Renal function remained stable, and the patient reported normal urinary function without pain or other urological symptoms. The surgical wounds healed appropriately, and no recurrence of the inguinoscrotal hernia was observed. Given the satisfactory postoperative outcome, the patient expressed the intention to proceed with the initially planned orthopedic procedure, namely total knee arthroplasty for advanced knee osteoarthritis.

Keywords: Nephroptosis, Inguinoscrotal hernia, Scrotal kidney, Knee arthroplasty, Biomaterials.