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Kidney Week

Abstract: SA-PO1129

Time Is Nephron: Chronic Urinary Bladder Herniation Resulting in ESKD

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Singh, Waryaam, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Ninan, Jacob, MultiCare Capital Medical Center, Olympia, Washington, United States
Introduction

Inguinal hernias involving the urinary bladder occur in 0.4-3% of cases. They are often asymptomatic but can result in lower abdominal discomfort, urinary tract infections, and kidney complications. We present a patient with an inguinal urinary bladder hernia presenting with end-stage kidney disease.

Case Description

43-year-old class 3 obese male was admitted for an enlarging right inguinal hernia. The surgeon advised him to return to the specialty clinic for his 8 month-long-lump after seeking urological assistance and deciding on his choice of surgical option offered. 3 weeks before admission, he was noted to be uremic and oliguric. On admission, his vital signs were stable, and physical examination revealed bilateral inguinal hernia, and lab results showed S. Cr 14.07mg/dL, BUN 226mg/dL, S. K 6.1mmol/L, and S. Bicarb 7mmol/L. The CT scan revealed a grossly distended urinary bladder herniating into the right inguinal canal and bilateral hydronephrosis. The patient declined kidney replacement therapy due to concerns about his quality of life. He was managed medically and discharged home on hospice care at his request. His S. Cr levels stabilized(in the high 7s), and he passed away one month after hospitalization.

Discussion

Urinary bladder herniation(UBH) can occur as direct inguinal hernia and, less commonly, as indirect inguinal or femoral hernia. Male gender, advanced age, obesity, bladder obstruction, and abdominal wall weakness are contributing factors. Most cases are asymptomatic, but some experience groin pain, urinary retention, hematuria, flank pain, or lower urinary tract symptoms. If left untreated, long-standing urinary bladder hernias cause renal failure, bladder perforation, recurrent stones, or hydronephrosis.
Symptomatic UBH usually require emergency management, initial drainage using a Foley catheter before definitive surgery. Ultrasound, computed tomography scan, or MRI can aid in diagnosis and surgical planning. Open repair of urinary bladder herniation involving reduction of the bladder, followed by a standard herniorrhaphy technique, is the typical approach; however, conventional and robotic-assisted laparoscopic repairs have also been reported.
UBH is a rare and overlooked condition more prevalent in high-risk populations such as overweight men. Timely diagnosis and surgical repair are crucial to prevent irreversible kidney damage and fatal outcomes.