Acute obstructive renal failure due to complete herniation of the bladder into the scrotum.

Massive herniation of the bladder into the scrotum is uncommon and can have a deleterious effect on the upper urinary tract. We report a case where complete scrotal hernia of the bladder lead to obstructive renal failure due to torsion of the trigone. Most simple bladder hernias can be explained by a prostate or uretral obstacle. The mechanism in our patient with no known prostate or uretral disease was the passage of the bladder via a defective inguinal canal caused by excessive obesity. This type of massive hernia has been reported in Sumo boxers. The effect on the upper urinary tract may be related to a fold in the terminal ureter or more exceptionally in the trigone. Immediate treatment requires urine drainage above the obstacle and intensive care. After stabilization, the anatomic position of the excluded bladder is re-established with reconstruction of the inguinal area, usually with a prosthesis. Any obstacle below the bladder must be removed.