Laparoscopic Repair of Large Bladder Herniation Presenting as an Inguinal Hernia
A 59-year-old man presented with a 1-year history of right scrotal swelling and irritative lower urinary tract symptoms (LUTS). He could occasionally void completely by manually compressing the inguinoscrotal mass area. He had no relevant medical history, including no abdominal surgeries. On physical examination, a 6-cm, nontender, reducible inguinal mass was noted that extended into the right scrotum (). No flank or abdominal masses were detected on examination. A digital rectal examination revealed a 20 g soft prostate. The patient's serum creatinine level was 1.0 mg/dL. The results of a urinalysis and urine culture were negative. The patient's International Prostate Symptom Score (IPSS) was 15.\nThe findings of a scrotal ultrasound examination were consistent with a right inguinal anechoic lesion extending into the right hemiscrotum (). A CT scan revealed that the right side of the bladder wall had herniated through the right inguinal canal (). Retrograde cystography showed massive herniation of the right side of the bladder, both anteriorly and inferiorly ().\nTo repair the hernia by laparoscopic surgery, the patient was placed in a supine position with slight Trendelenberg positioning. A CO2 pneumoperitoneum was established with a Veress needle. An 11 mm trocar, which was used as the camera port, was placed in the subumbilicus and in the right/left lower abdominal quadrant at the level of the midclavicle line. A 30°, 10-mm laparoscope was inserted into the peritoneal cavity. Laparoscopic repair of the BH was performed by a transperitoneal approach. A herniated bladder with part of the peritoneum in the right internal inguinal canal was found (). The herniated bladder and the right inguinal canal area were dissected from the peritoneum, and the herniated bladder was repositioned. The BH resection margin was distinguished from normal bladder tissue by frozen section. The 2 cm right internal canal opening was closed by suturing with 4-0 Vicryl (). The proximal margin of the herniated bladder portion, which was repositioned, was resected (), and we established a right ureterovesicular opening to the bladder by stretching the tissue. The defective portion of the bladder was closed in two layers by using 3-0 and 2-0 Vicryl. The specimen was removed from the 11-mm camera port without an additional incision. No saline leaked from the sutured portion of the bladder when the bladder was filled with saline through a Foley catheter. The bladder portion was resected, and the operative time was 150 minutes. The estimated blood loss was about 100 mL. The postoperative times to initiate ambulation and diet were 0.8 and 1 day, respectively.\nBH was confirmed by the pathological findings, including hypertrophy of the muscle layer. Seven days after the surgery, follow-up cystography showed a mild irregular contour on the repaired portion of the bladder (). The patient's bladder capacity was approximately 450 mL. The postoperative period was uneventful, the patient's symptoms disappeared, the patient's LUTS improved, and his IPSS was 10.