V08_No_4_Final_New.pdf


Case Report

333Urology Journal   Vol 8   No 4   Autumn 2011

Hydronephrosis Secondary to Sliding Inguinal
Hernia Containing the Ureter
Walid Atef Massoud, Pascal Eschwege, Pascal Hajj, Ayman Awad, 
Lahbib Aoubid Iaaza, Joseph Chabenne, Yacine Hammoudi, Stéphane Droupy, 
Gérard Benoit

Urol J. 2011;8:333-4.
www.uj.unrc.ir

Keywords: hydronephrosis, hernia, 
ureter, etiology, complications

Department of Urology, CHU de 
Bicêtre, Le Kremlin-Bicêtre, France

Corresponding Author:
Walid Atef Massoud, MD

CHU de Bicêtre, Department of 
Urology, 78, rue du général Leclerc, 

94275 Le Kremlin, Bicêtre, France
Tel: +33 699 114 939

Fax: +33 145 212 047
E-mail: walidmassoud@yahoo.fr

Received January 2010
Accepted April 2010

INTRODUCTION
Herniation of the ureter occurs 
infrequently in a sliding inguinal 
hernia. Significant herniation 
may cause ureteral 
obstruction leading to 
hydronephrosis.(1,2)

CASE REPORT
A 62-year-old man 
presented with the left 
flank pain. Physical 
examination revealed 
a left reducible 
inguinal hernia. 
Ultrasonography
showed a mild left 
ureterohydronephrosis.
Computed tomography 
scan demonstrated a 
loop of the left ureter in 
the inguinal hernia sac 
(Figures 1 and 2).

At operation, a large 
indirect sliding inguinal 
hernia was found. The 
ureter was dissected free 
of the sac, then reduced, 
and herniorrhaphy was 
done. Convalescence 
was uneventful 
and follow-up 
ultrasonography
showed resolving of the 
left hydronephrosis.

DISCUSSION
Scrotal herniation of the ureter 
is an extremely rare and often 
misdiagnosed condition with 

Figure 1. Computed tomography scan showing left 
ureterohydronephrosis and looping of the ureter into the inguinal 
hernia.



Hydronephrosis Due to Hernia—Massoud et al

334 Urology Journal   Vol 8   No 4   Autumn 2011

possible serious surgical complications. It is often 
determined during inguinal hernias surgery or 
sometimes fortuitously.(1) Most reported cases 

have occurred in obese men during the 5th and 6th
decades of life.(2,3) However, there may be another 
factor, such as the existence of a redundant ureter, 
which is located over the spermatic cord.(4)

Two anatomical variations of ureteral hernia 
have been reported. Almost in 80% of cases, 
the ureter slides beside the peritoneal sac 
(paraperitoneal type), which frequently contains 
other sliding organs, usually the colon. The other 
is characterized by the absence of a peritoneal 
sac; the herniated ureter is hidden within the 
retroperitoneal fat (extraperitoneal type).(2,4)

Herniation of the ureter may cause ureteral 
obstruction leading to hydronephrosis. Surgeons 
must be aware of this condition in order to 
carefully preserve ureteral integrity and avoid 
ureteral injury during hernia repair.

CONFLICT OF INTEREST
None declared.

REFERENCES
1. Ilgan S, Ozguven M, Emer MO, Karacalioglu AO.

Massive inguinoscrotal herniation of the bladder with 
ureter: incidental demonstration on bone scan. Ann 
Nucl Med. 2007;21:371-3.

2. Akpinar E, Turkbey B, Ozcan O, Akdogan B, 
Karcaaltincaba M, Ozen H. Bilateral scrotal 
extraperitoneal herniation of ureters: computed 
tomography urographic findings and review of the 
literature. J Comput Assist Tomogr. 2005;29:790-2.

3. Bertolaccini L, Giacomelli G, Bozzo RE, Gastaldi L, 
Moroni M. Inguino-scrotal hernia of a double district 
ureter: case report and literature review. Hernia. 
2005;9:291-3.

4. Sanchez AS, Tebar JC, Martin MS, et al. Obstructive
uropathy secondary to ureteral herniation in a pediatric 
en bloc renal graft. Am J Transplant. 2005;5:2074-7.

Figure 2. 3D abdominal and pelvic computed tomography scan.