LAPAROSCOPIC APPROACH OF HUGE INGUINO-SCROTAL BLADDER HERNIA
We present a case of a 65 y.o. man (BMI 30) with a huge right scrotal mass appeared 12 months before. The patient reported irritative LUTS with bladder outlet obstruction, and the IPSS score was 15. The scrotal examination revealed a soft scrotal mass with a variable size linked to voiding.
A scrotal sonography detected a hypoechoic lesion in the scrotum, which stretched proximally to the intra-abdominal portion of the bladder.
A cystography showed a herniation of the bladder into the right emi-scrotum.
The patient was submitted to a transperitoneal laparoscopic bladder hernia repair with a mesh plug fixation. The portion of bladder with the contiguous peritoneum was found in right deep inguinal canal. A mesh was positioned with a plug in order to repair the deep inguinal ring. The bladder did not present any leakage.
The operative time was 150 minutes. Patient was discharged within 72 hours. The cystography, performed two weeks after surgery, showed the orthotopic bladder location into the pelvis and no hernia recurrences, as confirmed by the scrotal ultrasound. At 3 months follow-up post voiding residual was not significant at the bladder ultrasound evaluation as well as irritative and obstructive symptoms decreased (IPSS score = 7).