Obstructive uropathy from complete bladder and bilateral ureteral incarceration within an inguinal hernia

A 59-year-old man with a medical history of hypertension, gout and obesity presented to the hospital with a chief complaint of worsening scrotal oedema. The patient endorsed associated symptoms of decreased force of stream on urination, stranguria and hesitancy with slight dysuria. Physical exam showed an effaced umbilicus and phallus with a hidden scrotum estimated to be 30×20×30 cm in size. Imaging and lab findings led to a diagnosis of total bladder herniation within an incarcerated right inguinal hernia. Surgical repair of the inguinal hernia and replacement of the bladder and ureters led to a resolution of urinary symptoms with no evidence of vesicoureteral reflux or urinary retention.