Inguinal hernia

Discussion with Dr Shaiful on my CP last time

Patient was a 57 years old Chinese gentleman electively admitted for surgical management for his underlying bilateral inguinal/ inguinoscrotal mass / swelling.

1. Started noticed suddenly? How he noticed? - during bathing/incidental/wearing cloth/after heavy lifting/return from gym. He described it as bulging in appearance/rounded/about a size of grape/ect..
2. He described it soft on touch. The swelling was localized, not extending to scrotal area
3. On & off or persistent?
4. Resolved when he lie down/massage/
5. Aggravated/prominent upon coughing/standing/heavy weight lifting/straining...
6. Nevertheless, he did not noticed any wound or ulcer, redness on the swelling area.
7. The swelling was associated with pain. If there is pain, describe the pain further.
8. However, it is not associated with pus, fever,  itchiness,penile discharges/swelling or ulcer elsewhere.
9. Not preceded with fall/trauma/insect bite.
10. He had no constituional symptoms such as. He had no history of PTB contact. (WHY?)
11. Not preceded with prolonged constipation/ hard stool/ recurrent cough/SOB/noisy breathing/ lower urinary obstructive symptoms such as hesitancy/poor urinary stream & bla2.(prostatism syndrome) 
12. He had sought medical attention? given medcation? Any investigation done? Blood / imaging done...not done...
13. Was told that it is mostly...?
14. Or he did not sought attention because worry of surgery/or thought it is not dangerous or life threatening..?
15. The swelling was progressively enlarged for past 5years whereby it reach to the size of/ extend to scrotum / unable to be reduced.
16. Nevertheless, there is no worsening pain/nausea/vomiting/abd distension/bla2...
17. 3 months prior to current admission....he noticed another swelling...bla2...similar in character as the 1st swelling...
18. Due to bilateral swelling / swelling unable to be reduced, he sought attn...what been done? Bla2...
19. That's why important u mentioned what been done during sought attention...such as "physical examination was done including per rectal examination and he was told that his prostate was not enlarged"
20. About the constipation....enough u said he had no history of constipation...
21. Unless if he is constipate, then mentioned a bit what contribute to his constipation /reason such as not taking vegetables/sedentary lifestyle....Means no need to explore diet if he had no constipation...

He noticed sudden swelling at right inguinal region 5 years ago when he was defecating. size described as 50 cents coin.
But the swelling only started to progressively increase in size associated with pain when coughing in 1 year, making him decided to retire from his job...lifting cements bag in construction sites since few years back.

And the last 3 monthes, he started to notice small swelling at left inguinal region visible when coughing/sneezing measures about 20 cents coin.
Only 2 months ago, he went to clinic in htaa, referred to surgeon, given date for admission for surgery.

Then i asked him to describe the pain. When coughing, the pain is sudden but gradually but gradually subsided within seconds. The pain was localized to the swelling. Severity is described as 4/10.

He was able to reduce the swelling himself or when lying supine.

He denied any straining in urination, denied nausea, vomiting. No changes in bowel habit.

He has no other underlying disease.

He is non smoker and non drinker.