併膀胱結石的膀胱疝氣和攝護腺肥大的處置討論：處置順序？

唐慈翊^1-2、溫聖辰^1,2

高雄醫學大學附設醫院²泌尿科;

 高雄醫學大學醫學院³泌尿學科

Management of Bladder Herniation with Intravesical Calculus and BPH: Which Comes First?

Tsz-Yi Tang^1-2, Sheng-Chen Wen^1,2

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;

²Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan

Case Report 

            An 67-year-old man with a medical history of coronary artery disease and recurrent urinary tract infections presented with worsening symptoms related to a 10-year history of left inguinal hernia. He reported that the left inguinal mass had recently increased in size and was no longer reducible. Additionally, he complained of severe lower urinary tract symptoms (LUTS). On physical examination, an inguinal hernia sac was palpated, containing a firm, immobile mass. Abdominal computed tomography (CT) imaging revealed bladder herniation into the left inguinal region with a bladder stone located within the herniated bladder (Figure 1). Under the impression of enlarged prostate with LUTS, left inguinal hernia, and bladder stone in the hernia sac, transabdominal preperitoneal (TAPP) hernia repair combined with laser enucleation of the prostate was recommended. During surgery, manual reduction of the herniated bladder was performed initially, following by laser enucleation of the prostate and cystolithrotripsy to fragment and remove the bladder stone. TAPP hernia repair was then initiated, with the identification of omentum and bowel within a direct-type hernia sac, which was retracted without difficulty. A large direct-type abdominal wall defect was noted. The defect was closed with 3-0 V-Loc suture (15 cm in length) (Figure 2), and a mesh was placed over the repair site. No complications were observed, and the patient remained recurrence-free at a one-year follow-up.

Conclusion

This case highlights the management of a large inguinal hernia complicated by bladder herniation in an elderly patient with significant LUTS. A combination of TAPP hernia repair with laser enucleation of the prostate allowed for comprehensive management of the patient’s symptoms and prevention of hernia recurrence, demonstrating the value of a multidisciplinary surgical approach in complex inguinal hernia presentations.