# Bladder Irritation without Mesh Penetration after Hernia Repair: A Case Report

## TL;DR

A rare case of bladder irritation after hernia repair is reported, caused by a folded mesh without direct bladder penetration.

## Contribution

This is the first reported case of bladder symptoms caused by a folded mesh without mesh migration into the bladder.

## Key findings

- Bladder irritation can occur due to a folded mesh near the bladder wall.
- Symptoms resolved after mesh removal and replacement.
- Cystoscopic and radiographic findings may appear normal despite bladder irritation.

## Abstract

Bladder irritation after inguinal hernia repair is typically associated with mesh migration into the bladder. Notably, no previous cases have described bladder irritation symptoms in the absence of direct mesh penetration. This report presents a rare instance of bladder symptoms caused by a folded mesh, despite normal cystoscopic and cystographic findings.

A 49-year-old woman presented with urinary urgency, incontinence, and chronic right inguinal pain for 3 years, 8 years after undergoing inguinal hernia repair using the modified Kugel method. Although cystoscopy and cystography revealed no abnormalities, pelvic CT and MRI demonstrated a curved fatty tissue protruding toward the bladder. Laparoscopic exploration confirmed the presence of a folded mesh adjacent to the bladder wall. The mesh was successfully removed and a new mesh was placed, resulting in complete resolution of the urinary symptoms and pain without postoperative complications.

In patients presenting with bladder symptoms after inguinal hernia repair, mechanical irritation of the bladder wall by mesh should be considered—even when cystoscopic and radiographic findings are normal.