Recurrent inguinal bladder hernia containing a large vesical calculus after unsuccessful stone retrieval during transvesical prostatectomy: a case report

Vesical hernia through the inguinal canal is an uncommon variant of a sliding hernia associated with bladder outlet obstruction in older men. Vesical stones present within a herniated segment of the bladder are extremely rare and often missed clinically. A 72-year-old gentleman presented with a 10-year history of right groin mass with lower urinary tract symptoms (urgency, frequency, dysuria) with hematuria for several months. Two previous inguinal hernias repairs and open transvesical prostatectomy due to benign prostatic hyperplasia were done 18 months before. There was a history of a vesical stone found preoperatively on ultrasonography, which could not be located at the time of the operation and its extraction was stopped. Due to persisting complaints and groin pain, further investigation was carried out. Ultrasonography and CT revealed recurrent ainguinal hernia with a bladder component and a 3 × 3 cm stone in it. Due to the patient’s refusal, preoperative cystoscopy was not performed. Open exploration of the groin confirmed the presence of extraperitoneal direct inguinal hernia with bladder and the stone within. Cystolithotomy allowed to extract a stone with a size 3.2 × 3.0 cm, made mainly of calcium oxalate monohydrate. The cystotomy was closed in two layers and a hernia repair was performed using Shouldice method with additional polypropylene mesh. The postoperative course was uneventful. At one-year follow-up, the patient was symptom free with no clinical evidence of the hernia recurrence and no radiological remnants of the stone on plain abdominal radiography. Lower urinary tract symptoms in a patient with an inguinal hernia require urological evaluation. Uncertain anatomy can be clarified with cross-sectional imaging like CT regarding the position of the bladder and hernia sac. If the stone cannot be found during the operation, it needs to be investigated because of its possible presence within a herniated segment of the bladder.