What is the treatment for a bladder hernia in the inguinal canal?

Treatment of Bladder Hernia in the Inguinal Canal

Surgical repair is the definitive treatment for bladder hernia in the inguinal canal, with careful preoperative planning required to avoid bladder injury. 1, 2

Diagnosis and Evaluation

• Clinical Presentation:

  • More common in older males (≥50 years old), especially those who are obese 2
  • May present with:
    • Inguinal or scrotal swelling/bulge
    • Lower urinary tract symptoms (LUTS)
    • Two-stage micturition (need to compress groin area to complete urination)
    • Dysuria and urinary frequency
    • Lower abdominal discomfort, especially during urination or coughing 2, 3

• Diagnostic Imaging:

  • MRI is currently the modality of choice to assess loco-regional disease 4
  • CT scan can demonstrate bladder protrusion into the inguinal canal/scrotum 1
  • Ultrasound may reveal widened inguinal canal with "teardrop" lesion 2
  • Cystography is considered the most sensitive test for diagnosis 3

Treatment Approach

Surgical Management

1. Preoperative Planning:

   • Careful surgical planning is necessary to avoid complications, particularly bladder injury 1
   • Consider urological consultation to exclude urological pathology 5
   • Bladder catheterization may be needed before surgery, especially if acute kidney injury is present 3

2. Surgical Technique:

   • Open surgical repair is preferred over laparoscopic approach 5
   • The procedure involves:
     • Reduction of the herniated bladder back into the pelvic position
     • Repair of the hernia defect
     • Tension-free mesh placement is the most common and preferred approach 2

3. Management of Bladder Involvement:

   • Small, well-differentiated lesions (<2 cm) may be managed with local excision 4
   • For larger hernias, the entire bladder must be carefully reduced
   • If bladder damage occurs during surgery, immediate repair is required 5

Special Considerations

• In cases with urinary obstruction or acute kidney injury, addressing the bladder hernia can lead to significant improvement in renal function 3
• Patients with small, asymptomatic inguinal bladder hernias might be candidates for conservative management 5
• Postoperative monitoring for urinary complications is essential

Complications to Watch For

• Bladder injury during surgery (occurs in a significant percentage of cases diagnosed intraoperatively)
• Urinary leakage
• Infection
• Hernia recurrence
• Urinary retention

Prevention of Complications

• High index of suspicion in at-risk patients (elderly males, obese individuals)
• Preoperative imaging when bladder involvement is suspected
• Careful surgical technique with attention to bladder anatomy
• Involvement of urologist when bladder herniation is identified

Bladder hernias represent only 1-4% of all inguinal hernias but require special attention due to the risk of bladder injury during repair. Most cases (93%) are diagnosed intraoperatively rather than preoperatively, highlighting the importance of surgeon awareness of this condition 1.