Scrotal mass in an inguino-scrotal ureteral hernia

Objectives. To present the clinical case of an inguino-scrotal hernia of the ureter, complicated by the presence of a urothelial carcinoma brought to our notice as painful scrotal swelling. Materials and methods. The patient is an 85-year-old male presenting an inveterate right inguinal hernia with acute and worsening scrotal pain. Upon examination of the hemiscrotum an inguinal hernia was found, associated with an irreducible, hard, painful mass, separate from the main part of the hernia, with didymis and epididymis not palpable. Neither signs nor symptoms of intestinal occlusion or peritonism were evident, nor were any urinary disorders reported. The patient was subjected to first-grade diagnostic examinations such as scrotal and renal ultrasonography and second-grade investigations including an abdominal-pelvic Magnetic Resonance Imaging, an intravenous urography and right-sided ascending pyelography. These imaging techniques gave the grounds for suspecting a right inguino-scrotal hernia associated with neoplasm of the interscrotal tract of the herniated ureter. Results. The patient underwent a surgical operation of right ureteral resection, vesical reimplantation and right inguinal herniorrhaphy. A right-side iliac/obturator lymphadenectomy was performed. The final results of the histological examination were as follows: urothelial papillary carcinoma G3, without metastases. Conclusions. Ureteral hernias are rare and to date no cases of neoplasia originating from the herniated tract of the urinary DUCT have been described. The diagnostic course of the painful scrotal masses must nevertheless include the assessment of a possible presence of an inguino-scrotal hernia of the ureter as well as the chance of there being a neoplasm originating from the hernia. The use of imaging techniques, permitting the examination of the uro-genital apparatus, has lead to the definition of such rare pathologies, thus furnishing a contribution to differential diagnosis of painful scrotal masses.