title: An unusual case of chronic urinary retention and bladder diverticulum presenting with unilateral lower limb swelling.
abstract: A 64-year-old man presented with 1 month of gradual-onset left leg swelling and lower urinary tract symptoms including enuresis, frequency and poor stream. He was initially treated for suspected cellulitis, however, he returned 2 weeks later with persistence of his symptoms. Routine biochemical investigation revealed renal failure (Cr 623, Ur 29.9) and hyperkalaemia (K 7.2). Abdominal examination revealed a distended urinary bladder and an ultrasound scan revealed hydronephrosis, confirming the diagnosis of chronic high-pressure urinary retention. A urinary catheter was passed that initially drained 1.5 litre of clear urine. Shortly after insertion, this became heavily blood stained. A CT kidney ureter bladder (CTKUB) revealed a large mass behind the bladder thought to represent either an abscess or tumour. Cystoscopic correlation showed this to be a large, narrow-necked bladder diverticulum tensely distended with clot. Following successful clot evacuation and decompression of the bladder the leg swelling resolved and renal function improved.
authors.affiliation: Department of Urology, Countess of Chester Hospital, Chester, UK. james.dyer@doctors.org.uk
authors.forename: James Edward
authors.initials: JE
authors.lastname: Dyer
authors.forename: Dev
authors.initials: D
authors.lastname: Gulur
authors.forename: Sanjay
authors.initials: S
authors.lastname: Das
authors.forename: Bo
authors.initials: B
authors.lastname: Pettersson
mesh_terms: D004240:Diverticulum / Q000150:complications*; D004487:Edema / Q000209:etiology*; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology*; D007866:Leg; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology*; D001743:Urinary Bladder / Q000002:abnormalities; D062885:Urinary Catheters; D016055:Urinary Retention / Q000150:complications*