title: Incisional bladder hernia and refractory urinary urgency after pelvic surgery: a case report.
abstract: BACKGROUND
  Isolated incisional herniation of the bladder is very rare following pelvic surgery and may present as suprapubic discomfort. We report a case of incisional bladder hernia following pelvic surgery presenting as refractory urinary urgency.
  
  
  METHODS
  A 70-year-old woman, para 2, presented with a long history of suprapubic tenderness and refractory urinary urgency following reconstructive pelvic surgery. Over the 3 years following her surgery, multiple physicians evaluated the patient but were unable to find a definitive source of her urgency. She had used multiple anticholinergic agents without relief of the symptoms. A complete urogynecologic evaluation, radiologic imaging and high clinical suspicion for incisional hernia revealed a bladder hernia. Surgical exploration confirmed the fascial defect and bladder hernia. Herniorrhaphy corrected the defect and relieved the patient's symptoms of refractory urgency.
  
  
  CONCLUSIONS
  An incisional bladder hernia may present as refractory urinary urgency following reconstructive pelvic surgery. Strong clinical suspicion can allow earlier diagnosis and surgical treatment of this rare condition. Primary herniorrhaphy offers successful repair of the fascial defect and resolution of the urgency symptoms.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, 3332 Rochambeau Avenue, Bronx, NY 10467, USA. glazarou@montefiore.org
authors.forename: George
authors.initials: G
authors.lastname: Lazarou
authors.forename: Kenneth
authors.initials: K
authors.lastname: Powers
authors.forename: Magdy S
authors.initials: MS
authors.lastname: Mikhail
mesh_terms: D000368:Aged; D005260:Female; D006547:Hernia / Q000150:complications / Q000175:diagnosis*; D059685:Herniorrhaphy; D006801:Humans; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D001745:Urinary Bladder Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014555:Urination Disorders / Q000209:etiology* / Q000473:pathology / Q000601:surgery