Case report
A 82-year-old man with chronic urinary frequency and incomplete voiding
presented fever and chillness for 3 days. Physical examination revealed
a large, right side scrotal mass which existed for more than ten years,
according to the patient’s statement. The size of mass reduced to some
degree after voiding. Kidney echo revealed bilateral hydronephrosis and
hydroureter. Urinary tract infection and acute kidney injuries were
diagnosed by blood exam and urine analysis. Foley catheter was placed in
order to relieve his voiding symptoms. Computed tomography revealed
right inguinoscrotal hernia containing a great portion of bladder (Panel
A, arrow), while bilateral ureterovesical junction were stuck inside the
scrotum, resulting in bilateral hydronephrosis and hydroureter. After a
course of levofloxacin treatment, we arranged total extraperitoneal
laparoscopic inguinal hernia repair. During operation, right direct type
inguinoscrotal bladder hernia was discovered (Panel B, arrow), while
left side direct type inguinal hernia was also noted. After gently
pulled the hernia sac and the bladder, we placed an anatomical mesh at
each side to fill up the defect. The patient discharge on post-operative
day 1, while his urinary complaint reduced significantly after
operation. During further follow up, there was no more hydronephrosis
noted through kidney, his renal function also improved as well.