Presentation
Difficulty urinating and progressively worsening pain in the scrotal region and back.
Patient Data
Large left inguinal hernia containing nearly the entire thick-walled urinary bladder. Resultant bilateral hydroureteronephrosis. Bladder wall thickening may reflect cystitis versus sequela of chronic bladder outlet obstruction due to prostatomegaly.
Uncomplicated colonic diverticulosis is noted.
Case Discussion
A 70-year-old male with a BMI of 39 kg/m^2 and a history of BPH presented to the emergency department with difficulty urinating and progressively worsening pain in the scrotal region and bilateral back. A Foley catheter was placed, which drained more than 500 ml of urine. Laboratory evaluation showed a urinalysis positive for WBC, RBC, bacteria, and leucocytes. A CT scan of the abdomen and pelvis noted a large left inguinal hernia containing the distended, thick-walled urinary bladder, leading to mild bilateral hydronephrosis and a continued residual amount of urine in the bladder. The patient was treated for a UTI prior to surgery. Left inguinal hernia repair was planned, and a TURP/prostatectomy was to be done with or following the hernia repair.
Co-author: Dina Dahhan, B.S.