title: Inguino-scrotal herniation of the ureter containing stones.
abstract: BACKGROUND
  Inguino-scrotal herniation of the ureter is a rare and difficult situation for a surgeon, especially if only recognized during inguinal hernia repair.
  
  
  METHODS
  An 83-year-old gentleman, with a previous history of radiation treatment for squamous anal cancer, presented with a large left inguinoscrotal hernia causing occasional pain at the base of the scrotum. Follow-up, post-radiation therapy CT scan showed a hernia sac containing the bladder and large bowel. Calcifications in the sac were interpreted as bladder stones, in keeping with the history of left renal calculi.
  
  
  RESULTS
  During hernia repair careful dissection revealed a herniated portion of the left ureter located alongside a large hernia sac, complicated by ureteral calculi. Following stones extraction and ureteral repair, hernia repair with mesh was successfully accomplished. Pathogenesis of ureteric herniation is reviewed.
  
  
  CONCLUSIONS
  A herniated ureter is potentially a source of serious renal or ureteral complications. When discovered, ureteric hernias should be surgically repaired. If preoperative detection of a ureter herniation alongside an inguinal hernia is missed, awareness of the existence of this condition may help avoid iatrogenic ureteral damage injury during a complex hernioplasty. Documentation of unexplained, sizeable and distinct calcifications in an inguino-scrotal hernia sac, particularly in a patient with a history of urolithiasis, may suggest the presence of a herniated, calculus-filled ureter. In such cases, retrograde pyelograms may be considered for a definitive diagnosis prior to surgery.
authors.affiliation: "De Blasi" General Surgery Division, Policlinico di Bari University Hospital, Bari, Italy. pretef@gmail.com.
authors.forename: F P
authors.initials: FP
authors.lastname: Prete
authors.affiliation: "De Blasi" General Surgery Division, Policlinico di Bari University Hospital, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pezzolla
authors.affiliation: "Chirurgia 1" General Surgery Division, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
authors.forename: V
authors.initials: V
authors.lastname: De Leo
authors.affiliation: "Chirurgia 1" General Surgery Division, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Palma
authors.affiliation: "Chirurgia 1" General Surgery Division, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Prete
mesh_terms: D000369:Aged, 80 and over; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D012611:Scrotum / Q000601:surgery; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
keywords: Inguino-scrotal hernia; Stones; Ureter; Urinary obstruction