Paravesical Granulomas Masquerading as Bladder Neoplasms: Late Complications of Inguinal Hernia Repair

Abstract

Paravesical granuloma formation after inguinal herniorrhaphy is a rare complication due to infected suture material. We present 8 cases of large paravesical granulomas masquerading as bladder tumors. Irritable symptoms predominate the symptom complex and accurate diagnosis can be obtained with multiple, sonographically guided, needle biopsies of the mass. An operation results in complete resolution of the symptoms, while nonoperative management may help to improve but not resolve the symptoms.

Iatrogenic changes in the urinary tract

“…Suture granuloma may rarely produce a mass in or adjacent to the bladder in response to silk sutures introduced at the time of herniorrhaphy or other surgical procedure, and long afterwards may produce a tumour‐like lesion . Bladder neoplasm was the clinical impression in most of these reported cases, and the patients presented with variable urinary symptoms, including haematuria, frequency and dysuria.…”

“…The process usually occurs in the bladder wall or perivesical tissue. Microscopically, there is a predominantly histiocytic reaction to suture with foreign body giant cells and varying degrees of fibrosis and chronic inflammation …”

Paravesical suture granuloma simulating a local recurrence of the immature sacrococcygeal teratoma

“…Other less common finding is groin swelling, with or without pain. Because PSG is a slowly developing chronic abscess, fever or leukocytosis does not always associate with all patients, as was in our case [5,6].…”

“…Value of the cystoscopy in diagnosis is poor, primarily because accurate prediction was difficult whether a mass was malignant or benign. Cystoscopy shows only extrinsic compression, and then biopsies reveal inflammatory changes, which is nonspecific [5,6].…”

“…Therefore, these lesions often pose a diagnostic and therapeutic dilemma. Moreover, PSG may mimic bladder carcinoma or lymph node metastasis, as well as it may associate with bladder carcinoma in the adults [1,[4][5][6][7]. Here, we report a PSG after left inguinal hernia repair in a child that mimics a local recurrence of the totally excised immature sacrococcygeal teratoma.…”