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.