Imaging of urinary bladder hernias.

Lorenzo E. Bacigalupo1, Michele Bertolotto2, Filippo Barbiera3, Pietro Pavlica4, Roberto Lagalla3, Roberto S. Pozzi Mucelli2, Lorenzo E. Derchi1 Bacigalupo LE, Bertolotte M, Barbiera F, et al. erniation of the urinary bladder is not rare. It is usually considered that 1–3% of all inguinal hernias involve the bladder [1], and Iason [2], in 1944, reported an incidence of 10% in men older than 50 years. Most bladder hernias involve the inguinal and femoral canals, with the latter more frequent in women, and a predilection for the right side has been reported. However, herniations through ischiorectal, obturator, and abdominal wall openings have also been described. Any portion of the bladder may herniate, from a small portion or a diverticulum to most of the bladder [1, 3]. The presence of a large bladder hernia with descent into the scrotum was termed by Levine [3] in 1951 “scrotal cystocele.” In young infants, protrusion of the lateral aspect of the bladder base can be seen as an incidental finding that is normal for their age. These “bladder ears” are related to the size and position of the bladder in infants and to the persistence of a large inguinal ring [1]. Damage to the herniated bladder during herniorrhaphy has been reported, and in the preantibiotic era, an unrecognized injury to the bladder could lead to infection, sepsis, and even death. To avoid intraoperative complications, it has been suggested that all men older than 50 years who have prostatism associated with a inguinal or femoral hernia should undergo radiographic studies to rule out involvement of the bladder within the hernia before surgical repair. In patients who do not undergo surgery, complications of herniation include possible upper tract obstruction and strangulation, infarction, and perforation of the bladder [1, 3, 4]. Tumors and calculi have been found within the herniated bladder.