Diagnosis and treatment of inguinal hernia of the bladder: a systematic review of the past 10 years

An Unusual Presentation of Bladder Carcinoma in a Visceral Hernia: A Case Report and Literature Review

INTRODUCTION

Bladder carcinoma (BC) is the most prevalent malignancy of the urinary system. These cancers are primarily seen in adults > 60 years old and mostly present with microscopic or frank hematuria or obstruction of the urinary system. However, these rare cancers can be found in hernias.

CASE PRESENTATION

This report discusses a rare, localized bladder urothelial carcinoma (UC) manifestation. The patient had presented with lower abdominal pain several times. However, no accurate diagnosis was made due to the unspecified pain features. After being referred to a radiologic evaluation with ultrasonography, a bladder hernia was detected entering the abdominal wall, and it contained an unusual mass. Further evaluations revealed the malignant feature of the tumor. The abdominal wall hernia was replaced, and a TURP procedure was performed. The resulting sample showed UC without the involvement of the muscle layer.

CONCLUSION

One of the most common malignancies of the urogenital and reproductive systems in male patients is BCs. They are most commonly seen in men older than 60 years old with a history of smoking. The prevalent manifestations of cancer are microscopic or macroscopic hematuria, urinary obstruction, and abdominal pain. A rare but previously reported bladder cancer location is within inguinal or abdominal hernias. The diagnosis of this cancer is not always straightforward, and delays can result in the spread of malignancy and the transition of the patient's clinical condition to a poorer prognosis.

CLINICAL KEY MESSAGE

The presentation of bladder cancer is not always accompanied by typical symptoms such as hematuria or urinary obstruction. Patients with persistent lower abdominal pain should be evaluated to rule out bladder malignancy. These tumors might be hidden within abdominal or inguinal hernias, and more radiologic accuracy is demanded for their diagnosis.

A Rare Case of Giant Inguinoscrotal Bladder Hernia as a Cause of Acute Respiratory Distress Syndrome

An inguinoscrotal hernia is a common condition in medical practice. However, an inguinoscrotal hernia involving the urinary bladder is a rare entity that can easily lead to diagnostic errors, resulting in inappropriate medical management. We report the case of a 77-year-old patient who presented to the emergency department with dysuria and testicular pain persisting for over a year. Clinical examination revealed a large, non-reducible inguinoscrotal hernia on palpation. Abdominopelvic computed tomography demonstrated a giant inguinoscrotal hernia containing almost the entire bladder, causing post-renal obstruction with upstream uretero-hydronephrosis. Emergency surgery was scheduled, involving inguinoscrotal hernia repair using the Lichtenstein technique. Postoperatively, the patient developed septic shock of urinary origin, complicated by severe acute respiratory distress syndrome (ARDS).

Successful laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernia of the bladder following bilayer mesh use: A case report

INTRODUCTION

The effectiveness of laparoscopic repair for recurrent inguinal hernias has been previously reported; however, recurrence following bilayer mesh use has rarely been reported. We report a case of successful total laparoscopic repair of a recurrent inguinal hernia of the bladder in which a bilayer mesh was used for the initial direct inguinal hernia.

PRESENTATION OF CASE

An 80-year-old man underwent hernia repair using a bilayer mesh for a right direct hernia 12 years ago. Computed tomography revealed a malignant neoplasm of the pancreas and an asymptomatic recurrence of a right direct hernia of the bladder. We performed a laparoscopic distal pancreatectomy and splenectomy for the malignant pancreatic neoplasm. Postoperatively, the patient complained of right inguinal pain and frequent urination. Therefore, 2 months after the pancreatic surgery, we decided to perform laparoscopic repair of the right recurrent inguinal hernia of the bladder. Regardless of severe adhesions attributed to the bilayer mesh in the preperitoneal space, we could safely and definitely complete the laparoscopic transabdominal preperitoneal repair. No postoperative complications were observed, and the patient was discharged on postoperative day 2.

DISCUSSION

In cases of recurrence following hernia repair using a bilayer mesh, both laparoscopic and anterior approaches may be challenging owing to the presence of adhesions.

CONCLUSION

Definite intraoperative identification of the urinary bladder and mesh placement in the hernia orifice are necessary for an effective laparoscopic approach. Laparoscopic hernia repair may be feasible in cases of recurrence following bilayer mesh use.

A new groin hernia classification with clinical relevance

INTRODUCTION

Groin hernia is one of the most commonly managed surgical diseases around the world. The typical question asked by patients is "Does my hernia require urgent surgery?". The currently available classifications are insufficient to stratify patients into different groups. We propose a new classification that incorporates diverse clinical elements together with anatomical and other vital information, which allows us to stratify patients into different groups.

METHOD

A task force was formed by the Hong Kong Hernia Society, working with international expert hernia surgeons. The framework of the classification system was formulated. Clinical elements that are important in groin disease stratification were identified. A comprehensive literature review was conducted using PubMed. Those which dictate the severity of the disease were selected and compiled to form the new proposed classification. Application of this classification model to a single hernia surgeon's registry in The Hong Kong Adventist Hospital Hernia Centre was done for initial evaluation.

RESULT

This new classification incorporates important clinical characteristics forming a total of nine grades of differentiation, together with the anatomical details and special information. This comprehensive system allows the stratification of patients into different groups based on disease severity. It also enables more accurate data collection for future audits, comparisons of disease progression over time, and the effect of different management strategies for different-stage patients.

CONCLUSION

This is the first classification system which incorporates essential clinical parameters, which allows the stratification of groin hernia into different stages. Further studies and validation should be performed to evaluate the usefulness and value of this classification in groin hernia management.

Laparoscopic transabdominal preperitoneal repair of inguinal bladder hernia: a case report

Inguinal bladder hernia is a rare clinical condition, and only a small number of reported cases have been treated by laparoscopic surgery. We report a case of a patient aged 65-year-old who presented to our outpatient care unit for a right inguinal swelling. Computer tomography (CT) imaging showed a direct inguinal hernia with bladder and epiploic content. We performed a laparoscopic transabdominal preperitoneal repair, which involved carefully reducing the bladder's protrusion from the hernial orifice. Subsequently, a mesh prosthesis was employed to treat the right inguinal hernia. This case represents an unusual instance of a successful laparoscopic repair for a right direct inguinal bladder hernia.

Strangulated Indirect Inguinal Hernia-Containing Bladder: A Case Report

Inguinal hernias involving the bladder are exceedingly rare and pose a diagnostic challenge. Identifying bladder involvement within an inguinal hernia is imperative to avoid iatrogenic bladder injuries and subsequent complications. Here we discuss a case of inguinal bladder herniation and bladder visualization using methylene blue dye intraoperatively. We present a case of a 45-year-old male who presented with a six-hour history of dysuria and a painful non-reducible right-sided groin mass that had previously been reducible for 17 years. Computed tomography demonstrated an irreducible indirect inguinal hernia-containing bladder. Open Lichtenstein repair was performed, and intraoperative methylene blue-dyed saline successfully identified the herniated bladder, preventing iatrogenic bladder injury. This case report demonstrates the importance of preoperative imaging and intraoperative visualization for the prevention of complications in a rare occurrence of a strangulated indirect inguinal hernia-containing bladder.

A case of indirect inguinal bladder hernia treated with laparoscopic transabdominal preperitoneal repair with high peritoneal incisional approach

BACKGROUND

Inguinal herniation of the urinary bladder is uncommon and those descending into the scrotum are even rarer. Although open anterior repair has been used for inguinal bladder hernia, the efficacy of laparoscopic herniorrhaphy has been reported in recent years.

CASE PRESENTATION

A 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient's postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery.

CONCLUSION

Preoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.

A Rare Case of Complete Inguinoscrotal Bladder Herniation With Ureteric Involvement: Assessing Diagnostic Challenges and Complex Surgical Management

Inguinoscrotal hernias involving the urinary bladder are exceedingly rare, constituting a small subset of inguinal hernias. We present a case of a 47-year-old male with long-standing scrotal enlargement and obstructive uropathy due to complete herniation of the bladder with ureteric involvement. Diagnostic imaging confirmed the condition. Following an open laparotomy, the bladder was reduced, and a modified Bassini technique with orchiopexy was used for repair. Recurrence of the inguinoscrotal hernia with evidence of the bladder in the scrotal sac required additional surgery. This case underscores the rarity, diagnostic complexity, and potential complications of inguinoscrotal bladder hernias. Specialized surgical techniques and a multidisciplinary approach are crucial for successful management, especially in cases of complete bladder herniation. Future considerations should include innovative approaches to enhance primary repair outcomes for extensive hernias involving the bladder.

Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias

PURPOSE

Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias.

METHODS

This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1-3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff's α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader.

RESULTS

The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia.

CONCLUSION

Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.

A Case of Asymptomatic Massive Inguinoscrotal Bladder in Acute Renal Failure

Inguinal hernia is a common condition that typically affects males in the age group of 50-70 years. While often asymptomatic or mildly symptomatic, complications such as urinary bladder herniation and obstructive uropathy can occur if left untreated. We present a unique case of a 60-year-old man with a body mass index of 37 kg/m2 with a 20-year history of untreated bilateral inguinal hernias. His condition progressed to a complicated right inguinoscrotal hernia involving the bladder, leading to obstructive uropathy, acute renal failure, and pulmonary edema. Diagnostic imaging revealed hydronephrosis and obstruction of the distal right ureter, necessitating several procedures, including diuretic therapy, a nephrostogram, a nephrostomy, and ultimately hemodialysis due to persistent renal failure. Surgical management was achieved through an emergent robotic-assisted repair of the right inguinal hernia using resorbable mesh while repairing the left hernia was delayed to mitigate potential risks. This case illustrates the severe complications that can arise from a longstanding untreated inguinal hernia, highlighting the importance of routine monitoring and early intervention. It also emphasizes the diagnostic role of different imaging modalities and immediate pharmacological and surgical intervention in managing such complications. Despite the commonality of inguinal hernia, a lack of timely treatment can lead to life-threatening conditions, necessitating a comprehensive approach to management to improve patient outcomes.

Inguinal Bladder Hernia Indirectly Treated With Prostate Artery Embolization

An inguinal bladder hernia (IBH) is an abnormal protrusion of the bladder into the inguinal canal accompanied by a peritoneum sheath that creates the hernia sac. Clinical presentations vary greatly from lower urinary tract symptoms (LUTS) and reduction in scrotal size after voiding to being entirely asymptomatic. Since inguinal bladder hernias are uncommon and often accompanied by varied and nonspecific symptoms, it is challenging to diagnose and rarely included in differentials. Currently, computerized tomography (CT) imaging with contrast or voiding cystourethrography is recommended for diagnosis. There is no consensus on the best treatment for inguinal bladder hernias, with options ranging from laparoscopic repair to catheterization. In this study, we report the case of inguinal bladder hernia in an 86-year-old male presenting with symptoms of recurrent hematuria and two failed voiding trials after a Foley catheter placement from prostatomegaly resulting in bladder diverticula, and IBH. He was treated with prostate artery embolization (PAE) to address LUTS related to benign prostatic hyperplasia (BPH). The resultant decreased prostatic volume resolved his symptoms of IBH, hematuria, and urinary retention.

A rare intraperitoneal inguinal bladder hernia (IBH) in a 58-year-old Indonesian male: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Inguinal bladder hernia (IBH) accounts for <5 % of inguinal hernias. As to our knowledge, this is the first case report of a rare intraperitoneal IBH in Indonesia.

CASE REPORT

Here we present a case report of a 58-year-old Indonesian male complaining of a groin mass on the right side since 1 year ago, accompanied by lower urinary tract symptoms (LUTS), two-stage micturition, lower abdominal discomfort and pain during urinating and coughing. Ultrasound revealed widened inguinal canal containing peritoneum and "teardrop" lesion at the inguinal continuing until the right scrotal. The patient was scheduled for open repair of inguinal hernia (herniorrhaphy) with tension-free mesh. Intraoperative findings include the entire bladder herniation located at intraperitoneal.

CLINICAL DISCUSSION

Symptoms of IBH include inguinal or scrotal swelling with or without pain, LUTS, two-stage micturition, to various symptoms owing to complications. Pre-operative imaging might help to confirm diagnosis. The definitive treatment of IBH is either reduction or resection of the herniated bladder followed by surgical repair (herniorrhaphy).

CONCLUSION

IBH is rare but should be suspected in older males (≥50 years old), individuals with weak abdomino-pelvic musculature, and obesity. Pathologies of the bladder, such as bladder outlet obstruction (BOO), chronically distended bladder, and decreased bladder tone related to benign prostate hyperplasia (BPH) or bladder neck stricture can also increase risk of IBH. Treatment with open repair of inguinal hernia (herniorrhaphy) with tension-free mesh is the most common and preferred surgical approach.

Massive inguinal herniation of the bladder with bilateral hydronephrosis, complicated by psychosis

Massive inguinal herniation of the bladder is rare. This case was made more dramatic by the late presentation and simultaneous psychiatric condition. A man in his 70s was found in his burning house and admitted for smoke inhalation. Initially refusing examination or investigation, on the third day, he was found to have massive inguinal bladder herniation, bilateral hydronephrosis and acute renal failure. After urethral catheterisation, bilateral ureteric stent insertion and resolution of postobstructive diuresis, the patient underwent open right inguinal hernia repair and return of the bladder to its orthotopic position. He also diagnosed with schizotypal personality disorder with psychosis, malnutrition, iron deficiency anaemia, heart failure and chronic lower limb ulcers. Four months later and after multiple failed trial of voids, the patient underwent transurethral resection of prostate with successful resumption of spontaneous voiding.

Our Cases and Literature Review for Presence of Bladder Hernias in the Inguinal Region in Children

BACKGROUND

The rate of bladder injury during inguinal hernia repair in children is not well known. However, it is known that bladder injury during childhood inguinal hernia repair places a serious morbidity burden on children. We sought to determine an algorithm to avoid accidental bladder injuries.

METHODS

Reports that included pediatric patients with inguinal hernias containing the bladder were searched. Keywords and mesh term searches were conducted in the MEDLINE, Scopus, and Web of Science databases. We reviewed our clinical records and found that two patients had inguinal hernias containing the bladder.

RESULTS

Nineteen articles reporting on 26 patients diagnosed with the presence of the bladder within the inguinal canal from 1962 to 2021 were included in this article. Our two patients were added to this group. Diagnoses were made incidentally during genitourinary radiological examinations (n = 3), intraoperatively during hernia repair (n = 7), or due to clinical symptoms and findings (n = 18) after standard hernia repair. Bladder augmentation was required for three patients.

CONCLUSIONS

During the operation, if there is any suspicion regarding the presence of the bladder in the inguinal region, we suggest performing a preoperative cystogram to confirm the position of the bladder and its injury. We recommend that the sac should be opened and the contents inspected before performing transfixion during high ligation of the hernia sac.

Sliding Inguinal Bladder Hernia: An Open and Minimally Invasive Robotic-Assisted Repair

Inguinal hernia repair, although a common procedure, can present in complicated ways such as a sliding inguinal bladder hernia (IBH). This rare type of hernia can alter a patient's quality of life by obstructing urination, requiring manual scrotal compression to fully empty the bladder, and lead to devastating complications such as hydronephrosis and kidney failure. Treatment is typically by open inguinal hernia repair with manual bladder reduction, but this method poses risks of iatrogenic injury to the bladder. Within this case series, IBH repairs via open and robotic-assisted laparoscopic procedures are compared, and the morbidity and mortality of each method are analyzed. Although risk of recurrence is similar for both procedures, robotic surgeries are linked to decreased postoperative pain and length of hospital stay. The ease of dissection of pelvic anatomy and detailed view of the associated structures that robotic surgery can provide during a complex hernia repair encourages its use for IBH.

Inguinoscrotal Bladder Hernia Mimicking Testicle Tumor

Bladder hernias usually begin asymptomatically and are discovered incidentally at the time of discovery. Preoperative diagnosis of bladder hernias is important to reduce the risk of bladder injury during surgery. Although F-18 FDG PET/CT is applied for oncological purposes, benign conditions should also be taken into account when evaluating the implants. In this article, a case of bladder hernia, which can be confused with pathological cancer involvement, with the diagnosis of F-18 FDG PET/CT performed in a 73-year-old male patient with renal cell carcinoma is presented.

Inguinal bladder hernia: differentials for a male groin mass

Inguinal bladder hernia (IBH) is an uncommon occurrence in males with a groin mass. It may be present with lower urinary tract symptoms but is often asymptomatic, making it a diagnostic challenge. IBH is frequently an incidental finding during surgery, which increases the risk of iatrogenic injury of the bladder. This report examines the case of a 77-year-old male who experienced a painful, reducible right-sided groin mass with acute urinary retention. Investigations conducted through computed tomography exhibited a right indirect inguinal hernia containing omental fat and a portion of the urinary bladder. The patient underwent a right open herniorrhaphy with mesh repair. This report presents a systematic approach to differential diagnoses for a male groin mass and its relationship to IBH.

Inguinal Bladder Hernia (IBH) managed by Lichtenstein technique: A case report

Inguinal bladder herniation (IBH) is an uncommon case, observed in only 1–5 % of all inguinal hernias. Obesity, the elderly, gender, and previous operations are vigorous determinants for IBHs. Symptoms depend on the size of the hernia. We report a case of an obese male aged 40 presenting with a bulge increasing gradually in the right groin with a history of two-stage micturition (Mery’s sign). With imaging-assisted diagnosis modalities (US, CT, and MRI), the patient was diagnosed with IBH. Although IBH is not common, it should always be suspected in patients with Mery’s sign and predisposing factors.

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Inguinal bladder herniation (IBH) is an uncommon case, seen only in 1-5% of all inguinal hernias.

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Although IBH is not common, it should always be suspected in patients with Mery’s sign and predisposing factors.

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Obesity, the elderly, gender, and previous operations are strong determinants for IBHs.

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In most literature, the management of bladder herniation is an open surgical approach.

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We report a case of a patient who was diagnosed with a bladder herniation inside the hernia sac and treated with the Lichtenstein technique.

Bilateral inguinal bladder hernias

Inguinal hernia may contain the bladder as one of its contents, while bilateral inguinal bladder herniation is rare. Urinary obstruction and obesity are associated with increased abdominal pressure and are risk factors of bladder herniation. Clinicians should be aware of the bladder hernia in elderly with chronic dysuria and obesity.

“Locus minoris resistentiae” and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia

Background

Conditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling.

Case presentation

Three cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general.

Conclusion

The simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.

Inguinoscrotal herniation of the bladder: A rare case of obstructive uropathy

Inguinoscrotal herniation of the bladder is a rare presentation of inguinal hernia that can result in significant complications if untreated. We describe a case of an elderly male with a delayed presentation of bladder herniation resulting in severe acute kidney injury requiring urgent placement of nephrostomy tubes. Ultimately surgery is required for definitive management.

Primary squamous cell carcinoma of the urinary bladder presenting as an inguinal mass

This report involves a rare case of a 74-year-old man who presented with a progressively increasing swelling in the right groin, which represented a squamous cell bladder carcinoma herniating into the right inguinal canal. The manuscript discusses the role of multimodality imaging in bladder carcinoma presenting as an inguinoscrotal hernia. The patient subsequently underwent treatment with a chemotherapy regimen consisting of 5-fluorouracil and mitomycin, which was extrapolated from squamous cell carcinoma of the anal canal, and responded well.

[Bladder hernia: report of a case series and review of the literature]

Inguinal bladder hernia accounts for only 1 - 4 % of all inguinal hernias. It may be difficult to diagnose due to the atypical symptoms. In most cases, the diagnosis is only made intraoperatively. However, a preoperative diagnosis is important to avoid possible iatrogenic complications. We report a case series of five patients with the rare pathology of bladder hernia treated in our department in the past 20 years.

A case of indirect inguinal bladder hernia treated by laparoscopic hernia repair

Inguinal bladder hernia is a rare clinical condition, and only a small number of reported cases have been treated by laparoscopic surgery. In the present case, the patient was a 78-year-old man who presented to our emergency department with a chief complaint of right inguinal bulge and pain. CT imaging revealed an incarcerated right inguinal hernia containing the small intestine and a portion of the urinary bladder. We performed manual reduction of the incarcerated intestine, and he was admitted to the surgical ward for follow-up. On the 19th day after discharge, recurrence of incarceration developed, and he was readmitted after manual reduction. A laparoscopic transabdominal preperitoneal repair was performed. After careful reduction of the protruding bladder from the hernial orifice, we repaired the right inguinal hernia with a mesh prosthesis. We experienced a rare case of right indirect inguinal bladder hernia that was treated successfully with laparoscopic repair.

Multiple Secondary Vesical Calculi in a Large Incarcerated Inguinoscrotal Bladder Hernia

Background: Inguinal herniation of the urinary bladder is rare. Although in most patients it is an incidental finding during hernia repair, some patients present with complications related to herniated bladder. Case Presentation: A 65-year-old man presented with recurrent lower urinary tract infections and multiple episodes of lithuria. He was found to have an incarcerated right inguinal hernia with a large part of the urinary bladder inside the hernial sac. He did not have any features of bladder outlet obstruction. The herniated bladder had multiple small secondary vesical calculi that had probably formed in this hernial sac. He was managed by open surgical mesh hernioplasty followed by cystoscopic stone evacuation. Conclusion: Incarcerated bladder herniation, complicated by intravesical stone formation, is a rare clinical condition. Proper preoperative imaging with CT scan best confirms the diagnosis. Appropriate treatment includes reduction of the bladder, hernia repair, and endoscopic stone management.

Urinary bladder-containing incarcerated inguinoscrotal hernia: a case report

Inguinoscrotal hernia containing the urinary bladder is a rare entity found in 1–4% of inguinal hernias, while patients rarely present symptoms of urinary dysfunction. We present the case of a 79-year-old Caucasian male with acute renal dysfunction and incarcerated inguinoscrotal hernia containing the entire urinary bladder. The patient presented in the surgical emergency department due to an incarcerated right inguinoscrotal hernia and deteriorated renal function. Preoperatively, ultrasound imaging was performed, which showed the presence of the whole bladder in the hernia sac. The bladder was repositioned to its anatomic position and hernia was repaired through a modified Lichtenstein technique. In patients with inguinoscrotal hernia and acute urinary tract symptoms, surgeons should be aware of the possibility of inguinal bladder hernia. Preoperative imaging can help in preventing intraoperative bladder damage.

Feasibility of robotic-assisted minimally invasive inguinal hernia repair in patients with urologic considerations including artificial urinary sphincters and bladder herniation

Robotic surgical technology has the potential to broaden the applicability of minimally invasive approaches into more complex, technically challenging inguinal hernia repairs. A unique patient population requiring inguinal hernia repair are those patients who either have artificial urinary sphincters (AUS) or inguinal bladder herniation (IBH). Traditionally, these patients have not been considered candidates for minimally invasive inguinal hernia repairs. Through this retrospective series, we aim to contribute to the growing body of literature on robotic-assisted inguinal hernia repair (RIHR) by describing our experience with RIHR in this patient subset. We performed a retrospective chart review of RIHR cases performed from June 2017 to April 2019 by a single surgeon at our university-affiliated community hospital. Charts were reviewed for preoperative considerations, operative complications, and postoperative outcomes. A total of three patients with an AUS and six patients with IBH were included, all of whom were male. All the patients received transabdominal preperitoneal (TAPP) approaches, and all received placement of mesh. There were no intraoperative complications and no conversions to open surgery. Postoperatively, one patient with IBH had persistent surgical site pain that resolved after 3 weeks and one patient, also with IBH, had a surgical site seroma that resolved without further intervention. Mean follow-up time was 10.71 and 12.13 months for patients with AUS and IBH, respectively. No patients reported hernia recurrence during this time. This review suggests that the use of robotic assistance for laparoscopic inguinal hernia repair is safe and effective and may provide additional benefits for patients with concurrent urological considerations such as AUS and IBH.

Massive bladder inguinal hernia leading to acute urinary retention

Bladder inguinal hernias are infrequently encountered in clinical practice. When present, the patient's main concern may be urinary difficulties such as retention. Careful history and physical examination will reveal the diagnosis in most cases, however, advanced imaging may be required. Emergent surgical consultation is required and urological consultation may be needed for preoperative planning and assistance. We present a case of a patient with almost complete herniation of bladder into left inguinal canal into the left hemiscrotum.

Rare giant inguinal hernia causing end-stage dialysis-dependent renal failure

A 72-year-old man presented with urinary retention, weight loss, haematuria and severe acute kidney injury. He had never before been admitted to hospital and his past medical history included only an inguinal hernia. On examination, he appeared uraemic and had a right-sided painful hernia. A three-way catheter was inserted, bladder washouts performed and irrigation started. An ultrasound showed severe bilateral hydronephrosis and a ‘thickened bladder’ and this was thought to be obstructive uropathy secondary to bladder cancer. Twenty-four hours later his hernia doubled in diameter, became incarcerated and a CT of the abdomen and pelvis showed an inguinal hernia of both bladder and bowel, with the catheter tip inside the bladder hernia. He was taken to theatres and an open mesh repair was performed with a rigid cystoscopy to assist in locating and reducing the bladder. He required intensive care and dialysis postoperatively and remains on regular dialysis following discharge.

Bilateral inguinal bladder hernia following unilateral transabdominal preperitoneal repair. A case report and review of the literature

Sliding hernia occurs when the hernia sac is partially formed by the wall of a viscus. The most common components of a sliding hernia includes the sigmoid colon, cecum, appendix, urinary bladder, and the ascending colon. However, the presence of bilateral vesical sliding hernia is rare and few cases have been reported in the literature. Patients with vesical sliding hernia may present with groin swelling with an associated lower urinary tract symptom. Computed tomography (CT) scan is the modality of choice for suspected cases which may reveal the classic pelvic micky mouse sign. The method of repair should be individualized taking in account the diagnostic findings. Although laparoscopic repair is becoming the mainstay management for inguinal hernia, the majority of sliding hernias are repaired using an open approach, which could be attributed to the presence of large hernias, associated complications, or recurrence with associated adhesions. We present a case of a 60-year-old male patient presented with bilateral inguinal swelling associated with urinary hesitancy and intermittency. He had undergone transabdominal preperitoneal (TAPP) repair for a left inguinal hernia 8 years ago. CT scan confirmed the presence of a bilateral hernia with the bladder herniating bilaterally. He underwent an elective bilateral open Lichtenstein tension-free mesh repair.

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Bilateral vesical hernia has been rarely reported in the literature.

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CT scan is the modality of choice for the diagnosis, which may reveal Micky mouse sign on an axial view.

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Laparoscopic and open repair have been reported for such cases.

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An open approach should be considered in large, complicated hernias, and those with extensive adhesions.