Abdurahmale A. Aldubaikhi, Sultan A. Albeabe, Ahlam M. Alfaraj, Talal M. Al Thobaiti, Salman S. Shaaban, Thamer S. Aloqaili, Alhanouf S. Aldossary, Sami N. Alanazi, Ziyad F. Althobaiti, Ebtehal Z. Alqahtani, Abdulrahguy Z. Alqahtani, Ali S. Alsoghayer, Abdulhalim A. Alabdullatif, Abdulwahab A. Altammar, Faisal Al-Hawaj


Published:January 06, 2022(watch history)

DOI:10.7759/soimg.org.20993

Cite this post as:Aldubaikhi A, Albeabe S A, Alfaraj M, et al. (January 06, 2022) Urinary Bladder Hernia: A Rare Cause of Urinary Frequency. soimg.org 14(1): e20993. doi:10.7759/soimg.org.20993


Hernia repair is one of the a lot of generally performed surgical operations worldwide. Inguinal hernia is a common condition and also has a high pervasiveness price. Modern age and male sex are the many important hazard components. Inguinal hernia commonly presents through groin swelling via abdominal discomfort. We report the instance of a 39-year-old male that presented to our urologic clinic through a complaint of urinary frequency for the last two months. This was associated through nocturia, feeling of infinish emptying, and groin swelling. There was no history of hesitancy, intermittency, or weak stream. The patient was otherwise healthy and balanced through no considerable previous clinical or surgical background. Ab examination confirmed a right groin swelling via associated visible and palpable cough impulse in keeping with inguinal hernia. Tbelow was no abdominal guarding or rigidity, and the abdomen was non-tender. Examination of the genitalia was unexceptional. No abnormal findings were listed in the examination of other systems. Routine laboratory markers did not show any kind of abnormalities. Urinalysis findings proved no leukocytes and also had negative outcomes for leukocyte esterase and also nitrites. A computed tomography (CT) sdeserve to shown the presence of a right-sided inguinal hernia, through part of the urinary bladder seen herniating into the right inguinal canal. The patient underwent a laparoscopic surgery in which the herniated bladder was decreased and the defect was closed with a synthetic mesh. The patient reextended with no complications. Postoperatively, the patient reported considerable development in his symptoms. Herniation of the bladder through the inguinal canal is an unwidespread surgical problem. The situation highlighted the prominence of considering this diagnosis when they encounter a patient with unexplained reduced urinary symptoms. Laparoscopic repair is a feasible and also safe alternative if the surgical team was knowledgeable with this method.

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A hernia is an abnormal protrusion of a viscus or component of the viscus through the body wall from the cavity in which it is usually included. Inguinal hernia repair is among the most frequently percreated operations international, through even more than 20 million operations percreated for groin hernia repair annually <1>. The life time pervasiveness of inguinal hernia exceeds 40% in men and 5% in women <2>. The threat variable for an inguinal hernia contains progressed age and male sex. Additionally, there is a positive family members history of inguinal hernia in the first-level loved ones. Interestingly, patients via low body weight have a higher tendency to build inguinal hernia <3>. The inguinal hernia deserve to be as a result of a congenital or acquired defect. In a congenital inguinal hernia, tbelow is a persistence of processus vaginalis, while the obtained congenital inguinal hernia is because of weakness in the abdominal wall <1>. Clinically, inguinal hernia often presents via a groin swelling through abdominal discomfort <2>. Here, we existing a situation of inguinal hernia primarily with urinary symptoms as a result of the presence of component of the bladder herniating with the inguinal canal, which is an amazing and also unprevalent clinical finding of inguinal hernia.


A 39-year-old guy presented to our urologic clinic via a complaint of urinary frequency for the last two months. He necessary to pass urine eincredibly three hrs. He additionally reported that this was connected through a solid desire to pass urine that he cannot defer. The patient was having actually bad quality of sleep as he needed to awake multiple times every night to pass urine. After urination, he had actually the feeling of incomplete bladder emptying. He also noted swelling in his appropriate groin. However, he reported that he did not suffer any kind of painful urination. There was no background of hesitancy, intermittency, or weak stream. Additionally, the patient did not experience any penile discharges. The patient checked out multiple clinics previously for his complaints and also was given symptomatic therapy with oxybutynin, which resulted in minimal development in his problem.

The patient was otherwise healthy via no considerable previous medical or surgical history. He was not taking any kind of medicines and had actually no known allergies. He was a non-smoker and never before consumed alcohol. He operated as an accountant. He had actually sex-related activity with one partner for the last 10 years. The family members history was substantial for cystic fibrosis. On examicountry, the patient appeared well and the crucial signs were within the normal range. Abdominal examicountry showed a right groin swelling through associated visible and also palpable cough impulse in maintaining through inguinal hernia. Tbelow was no abdominal guarding or rigidity, and also the abdomales was non-tender. Examicountry of the genitalia was unremarkable. No abnormal findings were noted in the examicountry of various other units.

Routine laboratory markers did not present any kind of abnormalities (Table 1). The patient had actually normal leukocytes count with normal worths of inflammatory markers. Urinalysis findings confirmed no leukocytes and had negative results for leukocyte esterase and also nitrites. Additionally, the urine society had no considerable bacterial development. To better characterize the inguinal swelling, the patient was described undergo an abdominal computed tomography (CT) shave the right to. The shave the right to confirmed the existence of a right-sided inguinal hernia. Part of the urinary bladder was herniating into the right inguinal canal. These findings were consistent via inguinal hernia containing component of the urinary bladder (Figure 1).


Laboratory InvestigationResultReference Range
Hemoglobin15.2 g/dL13.0–18.0
White blood cell9,200/mL4.0–11.0
Platelet375,000/mL140–450
Erythrocyte sedimentation rate5 mm/hr.0–20
C-reenergetic protein7.4 mg/dL0.3–10.0
Total bilirubin0.9 mg/dL0.2–1.2
Albumin4.7 g/dL3.4–5.0
Alkaline phosphatase49 U/L46–116
Gamma-glutamyltransferase21 U/L15–85
Alanine transferase17 U/L14–63
Aspartate transferase22 U/L15–37
Blood urea nitrogen9 mg/dL7–18
Creatinine0.8 mg/dL0.7–1.3
Sodium136 mEq/L136–145
Potassium4.2 mEq/L3.5–5.1
Chloride97 mEq/L98–107

*

Figure1:Axial CT images demonstrating right-sided inguinal hernia that included component of the bladder (arrow).

In view of these findings, the patient was referred to the urology team for even more monitoring. The decision to undergo surgical repair was taken. The patient underwent a laparoscopic surgical procedure in which the herniated bladder was decreased and the defect was closed through a artificial mesh. The patient reextended with no complications. Postoperatively, the patient reported considerable advancement in his symptoms. He had actually a close follow-up for six months, and he had no new complaints.


We reported a situation of a urinary bladder hernia via the inguinal canal, a rare form of groin hernia. Herniation of the urinary bladder is an unwidespread condition and occurs in less than 5% of all inguinal hernias <4>. The first explained instance of inguinal bladder hernia was reported by Levine in 1951 <5>. A bladder hernia is taken into consideration a straight inguinal hernia as it results from an gained defect in the abdominal wall musculature. It is commonly asymptomatic and detected incidentally on imaging research studies percreated for various indications <4>. However before, in our patient, the clinical manifeterminal was similar to that of an overenergetic bladder or acute cystitis.

Bladder hernia may acquire facility by urinary tract infection, urinary tract obstruction, bladder wall infarction, epididymitis, and malignancy <5>. It is crucial to note that up to 10% of patients via bladder inguinal hernia are diagnosed to have bladder malignancies <4>. In the current instance, no such complications were provided and the patient was treated promptly when the diagnosis was made.

Several investigation modalities can be valuable in giving clues for the diagnosis of bladder hernia. Such investigations incorporate ultrasound examination, cystography, CT, and magnetic resonance imaging (MRI) <5,6>. It is interesting to note that much less than 10% of patients through bladder hernias are diagnosed preoperatively <4>. The majority of patients through bladder hernias are diagnosed intraoperatively <6>. In the current situation, the diagnosis was got to preoperatively as the patient underwent a CT shave the right to as an investigation for his urinary symptoms and groin swelling.

Similar to all inguinal hernias, bladder inguinal hernia have to be repaired surgically as soon as the diagnosis is made to proccasion the incident of complications <4>. Hernia repair contains reduction of the herniated organ via the clocertain of the defect either mostly or by utilizing a artificial mesh material <6>. Partial rearea of the bladder could be forced in case of bladder infarction <5>. In the present instance, the bladder was not displaying any kind of proof of ischemia, and also no rearea was percreated. The surgical repair have the right to be percreated by open up laparotomy or laparoscopic repair <5,6>. We used the laparoscopic approach as the surgical team was experienced and also confident through this method and also because of its several benefits on patients, including diminished hospital continue to be.

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Herniation of the bladder via the inguinal canal is an uncommon surgical condition. The instance highlighted the importance of considering this diagnosis when they encounter a patient with unexplained lower urinary symptoms. The diagnosis deserve to be reached by cross-sectional imaging modalities. Surgical repair need to be perdeveloped promptly to prevent the occurrence of complications. Laparoscopic repair is a feasible and safe choice if the surgical team was skilled with this approach.