腹股溝腫塊-膀胱脫垂--案例報告
陳嘉宏1、黃子豪1,2,3、林登龍1,2,3
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科2書田泌尿科學研究中心3
Inguinal Bldder Hernia ─ A Case Report
Chia-Hung Chen1, Tzu-Hao Huang 1,2,3, Alex Tong-Long Lin1,2,3,
Department of Urology, Taipei Veterans General Hospital1; School of Medicine2 and Shu-Tien Urological Institute3, National Yang-Ming University, Taiwan
Introduction:
Inguinal bladder hernia is rare condition found in about 1–3% of inguinal hernia. We present a 74-year-old male with an intermittent right scrotal mass of 1 month
Case presentation:
A 79-year-old man had history of prostate adenocarcinoma, Gleason score 4+5, cT3aN0M1 under androgen deprivation therapy. He presented to the Emergency Department with sudden onset of right inguinal swelling and pain. The patient also complained of voiding and storage lower urinary tract symptoms prior to the admission. Examination revealed non-tender mass arising from the right inguinal region. Urinalysis and renal function test and serum chemistry parameters were normal. Incarcerated inguinal hernia was impressed. CT scan was arranged. Right inguinal hernia with the sliding right lateral wall of the urinary bladder was found (figure 1). The patient received surgical repair of the hernia under spinal anesthesia. Right inguinal incision was made. The herniated sac was dissected and reduced to the pelvic cavity. The floor of the right inguinal canal reinforced with Prolene mesh. Follow-up CT scan was done one month later and revealed no herniation(figure 2).
Conclusion:
Inguinal bladder hernia is rare condition found in about 1–3% of inguinal hernia. It is frequently unilateral, on the right side. Inguinal bladder hernia may be related to bladder outlet obstruction. Small bladder hernia is usually asymptomatic. Large bladder hernia may have some lower urinary tract symptoms such as frequency, nocturia, and urgency. The ureter can herniate with the bladder. It can cause ureterovesical obstruction with hydronephrosis. Catheterization prior to surgery is advised. Bladder hernia is repaired through the inguinal incision, the herniated bladder is reduced, and the inguinal floor is repaired with mesh. If a significant bladder outlet obstruction is present, correction of this condition is recommended.