Presentation of a Rare Case: Acute Kidney Failure Developed Following Complete Urinary Bladder Herniation and Management of Postoperative Voiding Dysfunction

Abstract

Inguinal bladder herniation is seen in 1% -4% of all inguinal hernia cases; most of them are asymptomatic and come up with swelling in the groin. In symptomatic cases, nonspecific findings such as lower urinary tract symptoms or pain due to strangulation of the hernia sac are seen. Two-stage micturition (manual pressure to the scrotum to empty residual urine) is a pathognomonic sign for the advanced case. Vesicoureteral reflux (VUR), bilateral hydronephrosis, urinary tract infection, acute kidney failure and bladder wall necrosis are complications that may be seen if the problem is not appropriately managed. Preoperative diagnosis rates are low (<7%) and 16% of the cases are diagnosed in the postoperative period, and most cases are detected intraoperatively. Radiologic examination performed for other indications such as non-contrast abdominal computed tomography (CT) may diagnose the bladder herniation. CT, cystography and ultrasonography are the techniques that can be used in the diagnosis and differential diagnosis. Intraoperatively, reduction of the herniated bladder with herniorrhaphy is a routine procedure. Partial cystectomy has to be made in case of bladder wall necrosis, presence of a tumor in the herniated bladder and narrow bladder neck which don"t allow reduction. In this case report, our aim is to explain the management of left inguinoscrotal complete bladder herniation and postoperative voiding problem.