Introduction: The condition known as scrotal cystocele occurs when the urinary bladder slides through the inguinal canal and fills the scrotum. It is a rare condition that typically affects obese male patients between the ages of 50 and 70. Massive scrotal cystocele in men younger than 45 or in the pediatric population is uncommon. Most people with scrotal cystocele are asymptomatic or present with the typical two-phase micturition with intermittent swelling that goes down after voiding. Presentation of the case: We present the case of a 44-yearold obese man who visited the radiology department with unusual symptoms, such as urinary frequency, urgency, nocturia, and suprapubic pain, along with scrotal enlargement. He was diagnosed as having a large scrotal cystocele based on his clinical history and radiological findings. Discussion: Rarely, reported cases include massive scrotal cystocele and left-sided ureter herniation. Preoperative diagnosis of IBH is important to lessen postoperative complications. Conclusion: Ultrasound, computed tomography intra-venous urogram (IVU), fluoroscopic cystography, antegrade IVU, and singlephoton emission computerized tomography aid to diagnose the scrotal cystocele or mimicking inguinal metastasis on bone scan.

Keywords: Scrotal cystocele, inguinal bladder hernia (IBH), “Chiragh”-like sign, Mery sign, inguinal metastasis, fluoroscopic cystography, antegrade IVU, CT-IVU, SPECT-CT, herniorrhaphy