Scrotal cystocele

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Large left sided scrotal swelling, urinary retention and hematuria.

Patient Data

Age: 80 years
Gender: Male
Ultrasound

US abdomen and scrotum

Large cystic structure is noted expanding the left hemi-scrotum with tapering upper pole at the scrotal neck.

Moderately enlarged prostate with calcifications.

Bilateral mild hydronephrosis with reflux nephropathy.

Gallbladder stone.

CT

CT Urography (prone position)

A large segment of the urinary bladder is herniated within the left scrotum through the left inguinal canal. Bladder shows mural thickening. This is associated with subtle surrounding fat stranding. Few small diverticula are noted at the left lateral wall of the urinary bladder.

The prostate is enlarged. Bilateral mild hydrocele is noted.

 Few bilateral cortical simple cysts are noted, largest is seen at the left upper pole 3 cm.

Both kidneys show grade II hydronephrosis with mildly dilated ureters. No evidence of dense obstructing stone along the urinary tract (secondary vesico-ureteric reflux is suggested).

Scans through the rest of the abdomen show tiny gallbladder stone, upper splenic pole cyst.

Right side perianal fistula is noted.

The organs appeared in opposite position as the patient is in prone position with applying the same technique of scanning.

Case Discussion

Scrotal cystocele is a type of urinary bladder hernia, where the bladder herniates into the scrotum. Chronic bladder distension (e.g. prostatism) may be a predisposing factor in such a case as there is associated prostatic enlargement. It is important to differentiate this condition in males older than 50 years from inguinal hernia of bowel to avoid bladder injury during herniorrhaphy. Herniation of bladder is seen in 1-3% of inguinal hernias. Delayed CT urography or retrograde CT cystography is the best modality for confirmation and prone position can enhance its visualization. US may identify the communication of the scrotal sac with the urinary bladder which gives a beaked appearance.

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Case information

rID: 54285
Case created: 2nd Jul 2017
Last edited: 22nd Jul 2017
System: Urogenital
Inclusion in quiz mode: Included

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