Inguinoscrotal Herniation of an Orthotopic Neobladder: A Rare Case Report and Literature Review.

INTRODUCTION

Bladder cancer (BC) is a common urological malignancy. Radical cystectomy (RC) is the standard therapeutic intervention for muscle-invasive BC (MIBC) and selected cases of non-MIBC, frequently necessitating subsequent urinary diversion. Orthotopic neobladder reconstruction is a commonly used option designed to preserve urinary continence. Delayed complications may manifest following RC and neobladder creation. This work presents a rare case of inguinoscrotal herniation involving an orthotopic neobladder, occurring 10 years after RC. To the best of our knowledge, this work is the first reported case of this complication managed through conservative treatment.

CASE PRESENTATION: A 58-year-old male with a history of RC and orthotopic neobladder substitution performed 10 years prior presented to the Emergency Department with pyrexia. Physical examination revealed a right-sided inguinoscrotal swelling. Diagnostic investigations confirmed a urinary tract infection. Ultrasonography identified the orthotopic neobladder within the hernia sac and determined a post-void residual volume of 400 cc. The patient was admitted for intravenous antibiotic therapy and correction of metabolic derangements. Planned surgical repair was deferred due to patient-specific factors and comorbidities. Manual hernia reduction was performed instead, followed by a regimen of four to six daily self-intermittent catheterisations, alongside lifestyle modifications and the prescription of a hernia truss. The patient has remained free of complications at 24 months of follow-up.

CONCLUSIONS

Inguinoscrotal herniation of an orthotopic neobladder is an uncommon delayed complication following RC. Although previous reports describe surgical correction, this work indicates that conservative management-encompassing clean intermittent catheterisation, behavioural modifications and external support-may constitute a viable alternative for selected patients unsuitable for or declining surgical intervention. Comprehensive patient education and diligent long-term surveillance are imperative for successful conservative management.