SCROTAL HERNIATION OF THE BLADDER SECONDARY TO PROSTATE ENLARGEMENT

Abstract

The roentgenographic findings of scrotal herniation of the bladder were first described by Levine in 1951.’ The term scrotal cystocele was used to describe the rare clinical condition of massive inguinoscrotal herniation of the bladder. Involvement of the bladder in inguinal hernias is not rare. However, herniation of a large portion of the bladder is uncommon. We report a case of massive inguinoscrotal herniation of the bladder secondary to large benign prostate hypertrophy. CASE REPORT A 78-year-old man presented with severe nocturia, a weak urinary stream, excessive straining and the need to squeeze the scrotum manually to void completely. Physical examination revealed a markedly enlarged prostate gland and a right inguinal hernia. Surgical history was significant for multiple repairs of the right inguinal hernia. Computerized tomography (CT) of the pelvis demonstrated a prostate gland measuring approximately 8 X 8 X 7 cm. (fig. 1, A). Subsequent images revealed the opacified bladder within the right inguinal canal, extending into the right hemiscrotum (fig. 1, B). Delayed supine images on excretory urography (Np) showed a large right inguinoscrotal herniation of the bladder with no evidence of ureteral displacement or dilatation (fig. 2). A simple retropubic prostatectomy revealed a 211 gm. benign prostate gland. The herniated portion of the bladder was reduced and elective hernioplasty was planned. DISCUSSION Herniation of the bladder may present as part of an obturator, ventral, ischiorectal, peritoneal or sciatic hernia. When the bladder is distended, it may also herniate into any pelvic or abdominal opening within its reach.2 Herniation of the bladder may be classified according to its relationship to the peritoneum. Paraperitoneal herniation is most common and is much more likely to be indirect. The bladder remains extraperitoneal being medial and alongside of the parietal