Pre Surgical Evaluation of Scrotal Cystocele by Conventional Radiography (Cystogram)
This report is of a 73-year-old male patient who presented to the surgical out patient department (OPD) with voiding difficulty for 8 months duration. He also gave history of a right groin swelling which gradually increased in size. He emphasized that he could empty his bladder completely, only if he pressed this swelling and swelling reduced in size on voiding but the swelling never disappeared completely. There was history suggestive of chronic obstructive pulmonary disease (COPD). There was no history of constipation. Patent underwent left herniorrhaphy about 15 years back. On examination, his general condition was unremarkable. His hernia was right sided, complete, direct inguinal, irreducible and was with no signs of inflammation []. With the age and voiding difficulty in consideration, benign prostatic hypertrophy (BPH) was made as the differential diagnosis. Also, BPH along with COPD was thought to have caused the hernia. As the patient could void without difficulty after manipulation of the hernial sac, BPH was ruled out. Rectal examination and prostate specific antigen (PSA) were normal.\nA retrograde cystogram was performed using water soluble contrast. It showed part of the urinary bladder in the pelvis and part in the hernial sac extending up to the base of scrotum with feeding tube seen in situ and conforming its wide mouth and continuity with bladder seen in suprapubic area. The cystogram was diagnostic of bladder herniation []. Patient was also subjected to ultrasonograpy to rule out BPH which was reported to be normal but ultrasonograpy showed continuity of groin swelling with bladder.\nOperative procedure included a right inguinal incision extended across the groin swelling medially. Urinary bladder formed the contents of the hernia []. The hernial sac not opened but urinary bladder was confirmed intra operatively by filling the bladder with normal saline with Foleys catheter in situ. The hernial sac containing urinary bladder was reduced. There were no intraoperative complications. No resection of the bladder was performed but only hernioplasty was carried out. The patient remained clinically asymptomatic, without voiding difficulty after surgery and recovered well.