Ureteroinguinal hernia with or without ureteral incarceration resulting in obstructive uropathy is an especially uncommon case. Ureteroinguinal hernia should be included in the differential diagnosis when a hernia is detected on physical exam or found on imaging concurrent with new or unexplained hydronephrosis. The present case illustrates the importance of recognizing this condition. This patient, with a history of renal transplant, was asymptomatic other than a reducible inguinal hernia on exam and an elevated creatinine on lab work. Nephrostomy tube placement, an important temporizing measure to relieve obstruction, and subsequent ureteral reconstruction with inguinal hernia repair was successful in preserving the patient's transplant kidney function. The management described may be helpful in guiding future surgical approaches to similar scenarios.