Inguinal hernia and concomitant varicocele mimicking mesh complication.

In males inguinal hernia and varicocele are frequent diseases with a reported incidence of 1-2 % for hernia (Klinge 2000) and up to 20 % (Mickevicius et al. 2002) for varicocele. In 1997 approximately 220,000 inguinal herniotomies were performed in Germany (Horeyseck 1997). Leading symptoms in both diseases are complaints and dragging pain in the inguinal region radiating into the testis. Surgeons treat traditionally inguinal hernia whereas varicocele is the domain of urologists. Coincident appearance of inguinal hernia and varicocele is expected to be more frequent with regard to the pathogenesis (Friedman et al. 1993; Nakada et al. 1994; Rosch et al. 2002; Rovsing 1916; Santoro et al. 2000; Wagh and Read 1972). Therefore both surgeon and urologist should see patients with inguinal hernia or varicocele. If patients with hernia repair postoperatively suffer from similar complaints again, it should not be interpreted rashly as mesh complication (Conze et al. 2001). The need for an improved assessment has been recognized (Kehlet et al. 2002). It sounds reasonable to assume, that quite a number of patients with complaints after successful hernia repair may suffer from an undiagnosed varicocele. We present a case of inguinal hernia with mesh implantation and concomitant varicocele as an example for mesh-unrelated postherniorrhaphy pain.