Hernia is one among those conditions that are often misunderstood, and associated with a particular experience. Hernia refers to a condition whenever there is a weakness or hole in the muscular wall that keeps the organs in place. Since, this condition is predominantly experienced in abdomen and groin, most individuals tend to associate it with these organs alone. However, it is necessary to note that hernia can occur elsewhere also, in addition to specific conditions. For instance, you can get hernia of the groin, belly button, hernia due to a surgical scar or hernia of the upper abdomen. There is another condition that a large number of individuals are unaware – hernia of the urinary bladder. This is not commonly prevalent, though it is not rare either. It is relatively lesser in prevalence and due to stereotypical inferences about hernia, most individuals are unaware of this condition. We will look closely at this condition and describe in details the symptoms, diagnosis and treatment options available.
What are the different types of hernia of the urinary bladder?
It is common to think of hernia of the urinary bladder as a term referring to the above condition. However, there are different types of herniation of bladder. This is used medically to determine the type of surgical management required and the condition. The general classification of hernia is basically – direct or indirect. In addition to this, other classifications include paraperitoneal, intraperitoneal, and extraperitoneal. The first condition is the most prevalent among all the three and refers to the hernia that is located on the medial wall. The second, intraperitoneal, refers to the bladder being fully covered by the membrane that covers the abdominal organs. The third refers to herniation where the bladder is not covered by the membrane in any way. These classifications are in a medical context and you need not necessarily be aware of this.
What conditions worsen the development of hernia
Certain conditions are known to worsen and contribute to the development of hernias. This includes smoking, pregnancy, COPD and obesity among others. Individuals who have undergone appendectomy earlier are also at risk. There is a body of evidence that suggests a link between hernia and genetics, with the condition witnessed more in certain families. Despite the fact that hernia is typically associated with heavy lifting, there is no evidence that links hernia of the urinary bladder with heavy lifting.
Symptoms that indicate hernia of the urinary bladder
Common symptoms that are associated with hernia of the urinary bladder include increased frequency and urge to urinate, a feeling of extreme urgency in passing urine, excessive urination during the nights (nocturia), pain and discomfort during urination (dysuria), and the presence of blood in urine (hematuria). Another symptom is the reduction in the size of the herniated sac after passing of urine. However, most individuals do not experience these symptoms and are typically asymptomatic, with incidental discovery of hernia. In other words, the condition of the individuals are discovered only during other evaluations – such as radiological.
Some of the reasons attributed to hernia of the urinary bladder include chronic bladder distension, lesions in the pelvic mass, inflammation of the tissues that are around the bladder, the presence of layers of fat around the bladder and loss of bladder tone.
Diagnosis of hernia of the urinary bladder
Diagnosis of hernia of the urinary bladder is typically through imaging. CT scan with or without contrast is considered as the most effective, due to the highly sensitive imaging enablement. This helps to diagnose herniation clearly, offering confirmation about other complications. For instance, CT scans have helped specialists determine the presence of hydronephrosis and bladder cancer in patients who underwent imaging diagnosis. Ultrasonograph is also used to diagnose the condition, but it is typically used in combination with cystography or CT scan. In many cases, cystoscopy has helped specialists to understand the complete hernia structure prior to the surgical procedure. Among the various diagnostic methods available, ultrasonograph is the easiest of all. CT is used for obese individuals while urologic diagnostics are typically used to confirm the diagnosis, in addition to assessing the condition of the prostate and the bladder. This includes flexible cystoscopy.
What are the distinguishable features of hernia of the urinary bladder seen during various diagnostics?
The various features that can be seen during diagnostics include the presence of a downward protrusion of the bladder wall during urography. Features seen during urography that indirectly indicate hernia of the urinary bladder include a small bladder that is asymmetric, and the inability to clearly visualize the base of the bladder. Centers that specialize in diagnostics choose the ideal position in which the radiograph is performed – fully erect or prone. This is because fully erect positions during radiographs give the clearest visualization of hernia of the urinary bladder. The second best option is the prone position, while the supine position is the least preferred as the visualization is likely to be missed.
Comparison of the different types of diagnostics in terms of imaging/results
With retrograde cystography it is possible to visualize bladder hernia clearly, while CT scan is good for visualization of herniations when the subject is placed in a prone position. Sonography is effective only when the lesions are large and can be difficult to see results otherwise. The results of MRI scans are reportedly similar to that of CT scans, with clarifications possible with coronal and sagittal planes. Overall, CT scans are regarded as most effective among other diagnostics on a relative scale. With the above listed diagnostic methods it is possible to determine the presence and extent of the herniation, with the best results attributed to CT scans.
Treatment options for hernia of the urinary bladder
Hernia of the urinary bladder has limited treatment options, and the most effective is surgery. This involves manual reduction of the cavity which will bring about a repair of the hernia through surgical means. Laparoscopic methods are popularly used to treat hernia of the urinary bladder. Some of the common hernioplasty methods that are typically employed include Lichtenstein, Bassini, Mac Way and Shouldice. The surgical procedures typically involve cystoscopy which permits an urologist to view the insides of the bladder in detail. Most procedures are ideally performed through two step procedures – the first is a laparoscopic reduction, followed by the placement of the mesh behind the wall muscle.
Documented reports reveal that various techniques have been attempted as part of surgical procedures for treatment of hernia. For instance, in the case of a patient who was reportedly in the ICU, a transscrotal cystostomy was performed. This procedure involved urinary catheter replacement. Patients with enlarged prostate typically undergo transurethral resection to treat the condition. Treatment options for all surgical procedures generally involve follow up actions and in the case of surgeries for hernia of the bladder, the follow up action varies and depends upon the condition. In some cases, follow up action may last for a few days, while in some cases, the follow up action could last for a few years. The follow up actions include clinical examination, or cystoscopy.
Benefits of surgical procedures to treat hernia of the urinary bladder
The benefits of surgical procedures are manifold, including improvements in other associated conditions. For instance, individuals with lower urinary tract symptoms draw benefits from surgical procedures used to treat hernia of the urinary bladder. It is important to note that in a large number of cases, side effects of surgical treatment of herniation are not diagnosed through routine physical examination. However, till date there are no recorded instances of fatalities as a result of such procedures or side effects of such procedures. Many recorded instances of indicate that the side effects (from surgical management of herniation of the bladder) was recognized due to other factors. For instance, some of the most popular instances include that of the presence of fluid observed when the patient was undergoing an operation, following which diagnoses indicated an injury to the bladder. In other famous examples, injury was diagnosed when the patient reportedly did not pass urine. This led to the discovery of an injury that was later surgically managed. Bladder injuries are possible during surgery and these are typically treated through cystorrhaphy and urethral catheter.
