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Inguinal hernias associated with bladder exstrophy

M D Stringer¹, P G Duffy, P G Ransley

¹Department of Paediatric Urology, Hospital for Sick Children, London, UK.

British Journal of Urology

|March 1, 1994

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Boys with bladder exstrophy have a high incidence of inguinal hernias, often bilateral and presenting in infancy. Early surgical intervention, including bilateral groin exploration, may reduce complications like incarceration and recurrence.

Area of Science:

Pediatric Surgery
Urology
Congenital Abnormalities

Background:

Bladder exstrophy is a rare congenital condition requiring complex surgical management.
Inguinal hernias are a known complication, but their incidence and specific risks in this population require further elucidation.

Purpose of the Study:

To determine the incidence and complication rates of inguinal hernias in patients with bladder exstrophy.
To evaluate the management and outcomes of inguinal hernias in this cohort.

Main Methods:

Retrospective review of 70 consecutive patients with bladder exstrophy undergoing staged reconstruction.
Analysis of inguinal hernia development, presentation, and management outcomes with a mean follow-up of 5.9 years.

Main Results:

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A high incidence of inguinal hernias was observed: 86% in boys and 15% in girls, frequently bilateral and presenting in infancy.
Boys experienced a significant rate of complications, including 29% with incarcerated hernias and 17% with recurrent hernias.
Recurrences in boys were associated with indirect sacs and occurred under 2 years of age; no recurrences were noted in eight boys undergoing herniotomy during bladder closure.

Conclusions:

Boys with classical bladder exstrophy managed with staged reconstruction have a higher incidence of inguinal hernias than previously reported.
These hernias are often bilateral, present early, and are prone to incarceration, suggesting a need for proactive management.
Bilateral groin exploration and meticulous inguinal herniotomy during bladder closure may decrease associated morbidity.