Tomas Staniulis1, Milda Musneckytė1, Paulina Abraitytė1
1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania
Inguinoscrotal hernia of the bladder is an unusual condition. It occurs in 1 – 4% of male population who suffer with inguinoscrotal hernia. Obese and older than 50 years old males who have inguinoscrotal hernia experience this type of pathology in 10% of all cases. Another risk factor for the condition is weak muscles in the pelvic floor. In case of inguinoscrotal hernia of the bladder, the bladder herniates to the inguinal or femoral canal, or the sac of the scrotum. The pathology usually appears with no specific symptoms. If symptoms appear, most prevalent are two stages of urination (then a patient presses his bladder manually in order to urinate), scrotum pain and swelling. Other symptoms associated with hernia of the bladder are groin pain, prostate hyperplasia, cystitits, vesicoureteral reflux, urinary retention, hematuria, edema of the scrotum, weak urinary flow and nocturia. Because of the rare specific symptoms, hernia of the bladder is usually diagnosed accidentally then investigating other pathologies of the urinary tract. Most commonly used diagnostic method for hernia in a bladder is ultrasonography because it is speedy as well as safe to use on patients of reproductive age. However, the golden standard of diagnostics is cystography which is highly sensitive and specific. Roentgenogram with contrast shows localization of the bladder, its size and morphological changes. Computer tomography (CT) scan is rarely used due to relatively high amount of ionization. Because of the rareness of the condition there are no standardized treatment guidelines. However, treatment is essential considering that Inguinoscrotal hernia of the bladder is associated with malignant processes and dangerous urological complications such as acute renal insufficiency as well as necrosis of the bladder. Surgeons choose open surgery in most cases. Lichtenstein is the most popular type of operation and Shouldice is the least used. Postoperative complications are rare. That being said, peritonitis, infection, infertility and others can occur. Accurate and timely pre-operative diagnosis of the inguinoscrotal hernia of the bladder is of the most importance because it reduces the chance of complications to a minimum.
Keywords: inguinoscrotal hernia; bladder.