INGUINAL CYSTOCELES - A PREVIOUSLY OVERLOOKED ETIOLOGY OF PROSTATISM IN MEN WITHOUT BLADDER OUTLET OBSTRUCTION

Purpose: We determine whether inguinal cystoceles, a type of extraperi toneal herniation of the bladder, are responsible for symptoms consist ent with prostatism in men without bladder outlet obstruction. Materia ls and Methods: From January 1996 to February 1997 inguinal cystoceles were treated with surgical repair of the floor of the inguinal canal in 8 men with a relatively long history of symptoms consistent with pr ostatism. The diagnosis of inguinal cystoceles was based on the fillin g phase of video urodynamic studies done with the patient standing. Th e clinical outcome of surgery was assessed using the International Pro state Symptom Score and urodynamic findings. Results: All inguinal cys toceles studied were physically occult but clearly detected as wide-mo uthed, mild protrusions of the bladder wall in the inguinal region on cystograms obtained with the patient standing. Although clear cystocel es were present on radiography on the right side in 1 case, the left s ide in 2 and bilaterally in 5, apparent bilateral weakness in Hesselba ch's triangle was noted in all at surgery. High detrusor opening press ure and a relatively long opening time mere regarded as urodynamic par ameters characteristic of this condition. These parameters and subject ive symptoms dramatically improved after bilateral surgical repair of the floor of the inguinal canal. Conclusions: Inguinal cystoceles nega tively affect voiding dynamics by increasing opening pressure and open ing time, indicating that they should be considered in the differentia l diagnosis of men with symptoms consistent with prostatism. Video uro dynamics is mandatory to detect this condition, which to our knowledge has been previously overlooked on radiography and urodynamics.