A 78 year old obese male with narrow angle glaucoma, BPH, hiatal hernia, abdominal hernia and right inguinal hernia presents with longstanding urinary symptoms of weak stream and incomplete emptying with increased urinary frequency and urgency during the day, while denying any history of gross hematuria or recurrent urinary tract infections. An initial renal ultrasound was obtained to assess his urinary symptoms, suggesting 1 nonobstructing stone in the left kidney without hydronephrosis. A CT scan to delineate the size and location of his stone confirmed that the patient in fact had one 6mm nonobstructing stone in the lower pole of the left kidney, however an incidental finding of a portion of the patient’s urinary bladder herniating into a large right inguinal hernia was reported (Fig.1). Patient was subsequently followed by surgical service, where he opted for an expectant management approach. The patient’s overactive bladder symptoms were managed with β3-receptor agonist Mirabegron as opposed to anticholinergic medication which is contraindicated in narrow angle glaucoma.
While inguinal hernias are common, affecting between 5-10% of the United States population, urinary bladder involvement in inguinal hernias is rare. Noted in less than 5% of inguinal hernia cases, involvement of the urinary bladder can develop due to numerous etiologies, including but not limited to advanced age, obese body habitus, and obstruction of the urinary outlet, all of which were noted in the patient presented here. The finding of small bladder hernia is usually incidental during workup and imaging performed for other conditions. Patients with larger and clinically evident hernias often describe a decrease in scrotal volume after voiding or report 2-stage urination, where voiding is completed after patient applies pressure to the scrotum. Left untreated, urinary bladder inguinal herniation can have a myriad of complications, including urinary tract infections, renal failure, hydronephrosis, vesicoureteric reflux and strangulation of the bladder within the hernia, causing subsequent infarction to the bladder and necessitating subtotal cystectomy. In cases where the inguinal hernia is small with tolerable symptom burden for the patient, an expectant management approach if often appropriate. Larger hernias with genitourinary symptoms not adequately managed with conservative treatment are often successfully managed with an open surgical technique, although increasing reports of laparoscopic repair have been reported.
Hospitalist knowledge of urinary bladder herniation is crucial in order maintain a high level of suspicion in patients who have symptoms of overactive bladder in the setting of an inguinal hernia. This rare condition requires thorough evaluation to determine optimal treatment modality to mitigate the numerous complications the patient may experience.
To cite this abstract:Zaidi, AH; Sheikh, AA . URINARY BLADDER IN INGUINAL HERNIA: AN UNCOMMON FINDING. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 803. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/urinary-bladder-in-inguinal-hernia-an-uncommon-finding/. Accessed February 21, 2020.