ACUTE OBSTRUCTIVE RENAL-FAILURE DUE TO CO MPLETE HERNIATION OF THE BLADDER INTO THE SCROTUM

Massive herniation of the bladder into the scrotum is uncommon and can have a deleterious effect on the upper urinary tract. We report a cas e where complete scrotal hernia of the bladder lead to obstructive ren al failure due to torsion of the trigone. Most simple bladder hernias can be explained by a prostate or uretral obstacle. The mechanism in o ur patient with no known prostate or uretral disease was the passage o f the bladder via a defective inguinal canal caused by excessive obesi ty. This type of massive hernia has been reported in Sumo boxers. The effect on the upper urinary tract may be related to a fold in the term inal ureter or more exceptionally in the trigone. Immediate treatment requires urine drainage above the obstacle and intensive care. After s tabilization, the anatomic position of the excluded bladder is re-esta blished with reconstruction of the inguinal area, usually with a prost hesis. Any obstacle below the bladder must be removed.