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Background
Inguinal hernias are among the most common types of hernia, especially in elderly male population. Increases in intra-abdominal pressure as well as congenital or acquired abdominal wall defects are contributing factors to the aetiology of this type of hernia. As with incidence of hernia, benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) prevalence increases with age. To overcome the increased pressure from bladder outlet obstruction due to BPH, patients strain with urination. Hence, BPH severity and the subsequent chronic increase in intra-abdominal pressure are correlated with the incidence of inguinal hernia as well as trabeculation and formation of a bladder diverticulum. 1 Bladder diverticulum is herniation of the urinary mucosa through a weakness or absence of the detrusor muscle. The peritoneal sac of the inguinal hernia may contain intraperitoneal viscera. However, the herniation of extraperitoneal organs such as bladder components is a rare entity. These organs are not included in the sac, but are pulled into the canal due to traction of the sac. 2 Herniation of a bladder diverticulum through the inguinal canal is a rare finding. Herein, we present an unusual case of recurrent indirect inguinal hernia with a giant bladder diverticulum and follow-up of the patient after surgical treatment.
Case presentation
A man aged 79 years was referred to our urology clinic with recently exacerbated dysuria, and nocturia during the past 6 months in addition to his chronic straining, frequency, terminal dribbling and reduced urinary stream. The patient denied any recent urinary tract infections (UTI), haematuria, history of kidney or bladder stone or urinary retention. He also reported a large soft inguinal mass on the right side which fluctuated in size with bladder distension. Meanwhile, he had a history of bilateral indirect inguinal hernias 12 years ago, which had been managed by herniorrhaphy. Physical examination revealed an enlarged prostate of ~80 cc and an inguinal hernia at the right side.
Investigations
Urinalysis, blood urea nitrogen, creatinine as well as other routine laboratory tests were within normal limits. The latest prostate-specific antigen (PSA) level 2 weeks prior to clinic visit was 7.0 ng/mL. Owing to the patient's advanced age, stable PSA values and extremely low PSA density, the shared decision between the patient and the physician was to not carry...