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A Hernia of the Urinary Bladder

1965; Radiological Society of North America; Volume: 84; Issue: 2 Linguagem: Inglês

10.1148/84.2.270

1527-1315

Joshua A. Becker,

Urological Disorders and Treatments

Herniation of the urinary bladder into an inguinal or femoral hernia has been known since the Middle Ages, with the first record of this entity by Plater in 1550 (10). The radiographic demonstration of such a hernia is uncommon, despite its description by Robins as early as 1929 (7). The incidence of bladder herniation in patients with inguinal hernia has been estimated at 1 to 3 per cent by some authors (4, 8) and as high as 10 per cent by Iason (2). Because of the proximity of the bladder to the inguinal and femoral canals, the degree of herniation will vary from a small protrusion to a massive one which represents less than 1 per cent of the bladder hernias. The majority of patients are males over the age of fifty with either direct or indirect inguinal hernias. Watson reports a l-to-3 ratio of femoral-to-inguinal bladder herniations, with the femoral more common in women, in conformity with the usual predominance of femoral hernias in females. Interesting, but not explained, is the fact that the majority of femoral hernias are on the right side (3, 10). Rarely, the bladder herniation may also present as part of an obturator, a suprapubic (through the linea alba), an ischiorectal, or a Gironcoli hernia (through the rectus abdominus muscle) (2). Classification Inguinal hernias of the bladder are classified in regard to their relation to the peritoneum. I. In paraperitoneal hernia (Fig. 1, A), the bladder remains extraperitoneal and is medial to the peritoneal herniation. The hernia may be direct or indirect in the inguinal area. This is the most frequent bladder herniation, with Watson reporting 251 instances in 286 cases and Wakeley (9) reporting 48 in 75 cases. II. In intraperitoneal hernia (Fig. 1, B) , the bladder is completely covered with peritoneum in the hernial sac. This type is second in frequency of bladder hernia in Wakeley's series, with 15 of 75 cases presenting in this manner, and least common in the series of Watson with 35 of 386 cases. III. In extraperitoneal hernia (Fig. 1, C) , the peritoneum remains in the abdomen and the bladder alone herniates. Watson considers this type second in frequency with an incidence of 120 of 386 cases, but Wakeley notes that it is rare with only 3 of 75 cases reported. The remaining types of bladder herniations are not subdivided. The hernia contains all segments of the bladder wall and does not represent a diverticulum in the usual case, although the herniation of a bladder diverticulum has been reported (4). Bilateral bladder hernias are rarely found (10). Symptoms The symptoms referable to herniation of the bladder can be typical. Usually the patient reports two-stage urination.