膀胱疝氣的診斷與治療-兩個病例報告
蔡佳宏1、陳彥達1、康智雄1
高雄長庚紀念醫院 泌尿科1
Diagnosis and treatment of bladder hernia
-report of two cases
Chia-Hung Tsai1, Yen-Ta Chen1, Chih-Hsiung Kang1
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: The bladder hernia occurs in 1% ~ 4% of cases of inguinal hernias. We present two cases who were diagnosed by different methods and the surgical treatments.
Case presentation – Case 1
This 61-year-old man had underlying disease of hypertension, type 2 diabetes mellitus and obesity. Right inguinal bulging mass was noted for several months. The mass was reducible and painless. Symptoms of bladder fullness and urinary urgency were accompanied when the mass bulged out, and were relieved after urination. Due to the above symptoms, he came to our outpatient department for help. Sonogram showed a right inguinal hypoechoic lesion which was connected with bladder and enlarged when doing valsalva maneuver. Bladder herniation was impressed. We also arranged IVP to confirm this diagnosis. He received operation under general anesthesia. Right inguinal incision was made and huge defect of posterior wall with bladder protruding. The defect was repaired with BARD PerFix mesh. His lower urinary tract symptoms improved after operation.
Case presentation – Case 2
This 71-year-old man had underlying disease of chronic kidney disease, hypertension, type 2 diabetes mellitus and benign prostate hyperplasia. He also had operation history of appendectomy and left inguinal herniorrhaphy. He suffered from right inguinal bulging mass for one year. The mass enlarged when bladder distension and resolved after urination. He visited our outpatient department for this disturbing mass. Abdomen CT was arranged and urinary bladder herniation into the right scrotum was found. He had hernia repair operation under general anesthesia. Hernia sac with bladder was separated from cord vessels and vas deferens. ProGrip mesh was used for posterior wall repair. Urination discomfort relieved after surgery.
Conclusions: The patient with bladder hernia may suffer from inguinal mass accompanied with lower urinary tract symptoms. High BMI and prostate hyperplasia are risk factors of bladder hernia. Sonogram, IVP and CT are the good diagnostic tools. Open and laparoscopic herniorrhaphy with mesh repair are both suitable treatments. Preoperative identification of bladder herniation is important to prevent iatrogenic bladder injury during operation.