Inguinal bladder hernia with bilateral hydronephrosis: a case report of urodynamic and functional recovery...

We report a case of a 50-year-old man referred to our department with a marked inflammatory response and severe renal dysfunction. Computed tomography scans revealed an inguinal bladder hernia with bilateral hydronephrosis. A urethral catheter was placed to relieve urinary retention, and antimicrobial therapy was initiated for pyelonephritis. Despite adequate urine output, renal function improved only partially, and hydronephrosis persisted. Further imaging and intraoperative findings confirmed that the hernia sac was adjacent to the bladder and the bilateral lower ureters, which were significantly stretched and displaced. Firm adhesions between the bladder and the hernia sac necessitated meticulous dissection to restore normal anatomy. Surgical repair of the inguinal hernia successfully repositioned the bladder. Although morphological upper urinary tract dilation persisted postoperatively, a mercaptoacetyltriglycine 3 renal scan demonstrated no evidence of functional obstruction, indicating improved ureteral patency. A urodynamic study (UDS) revealed significantly decreased bladder compliance, likely due to chronic displacement and compression within the scrotum, which impaired the detrusor function. The patient gradually regained spontaneous voiding after urethral catheter removal and initiation of clean intermittent catheterization. Follow-up UDS confirmed a substantial improvement in bladder compliance, indicating functional recovery. Follow-up imaging indicated the resolution of bilateral hydronephrosis and improvement of renal function. This case emphasizes the importance of recognizing lower ureteral entrapment in cases of bladder hernia and demonstrates that bladder dysfunction due to chronic displacement can be reversed by timely surgical intervention.