Chronic urinary retention

Case contributed by Dr Chris O'Donnell

Presentation

Swollen left leg ? venous obstruction. Normal duplex ultrasound. No urinary symptoms.

Patient Data

Age: 65
Gender: Male

Initial CT at 1600 hours

Modality: CT

Very large bilobed cystic mass arising in the pelvis with gross hydronephrosis and hydroureter right > left. Mass has 2 lobes: on the left is thick-walled and trabeculated (containing a calculus) consistent with the bladder and on the right is thin-walled and communicates with the bladder via a defect in the wall = pseudodiverticulum. Left leg swelling is due to extrinsic compression of the left iliac veins.

Repeat CT following insertion of urinary catheter at 2100 hours

Modality: CT

Following catheter insertion and 5 hours delay the mass has "disappeared" with 4 litres of urine in the catheter bag. The bladder is collapsed and markedly thick-walled. Note contrast in the dilated left renal collecting system down to the bladder, but poorly functioning right kidney due to chronic backflow obstruction.

Cause is presumed to be bladder outlet obstruction (possible due to the prostate or other urethral stricture). Note the so-called stasis bladder stone.

Case Discussion

Despite the gross findings, the patient was said to be asymptomatic with regard to the urinary tract. This shows how bladder outlet obstruction can slowly "creep up" on the patient without pain, i.e. chronic bladder retention.

The bladder does not have the findings of a neurogenic bladder (i.e. Christmas tree configuration), the other major cause of painless enlargement of the bladder.

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Case Information

rID: 34678
Case created: 4th Mar 2015
Last edited: 21st Nov 2015
System: Urogenital
Inclusion in quiz mode: Included

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