A 65-year-old woman is admitted to the hospital for constant, severe abdominal pain that has worsened over the prior week. She has no other associated symptoms, such as nausea or vomiting, but has noticed that her daily urine output has sharply decreased. She has had a constant desire to urinate, but, when she tries, only a small amount of bloody urine is discharged. The patient is a long-time smoker, having smoked three packs per day for more than 45 years, although she claims to have quit 2 days ago. A bladder ultrasound in the emergency department reveals a mass consistent with bladder cancer, as well as significant urinary retention. Which of the following is most likely to be detected upon imaging the patient’s genitourinary system?
a) Bilateral hydronephrosis
b) Bladder dilation
c) Bladder dyskinesis
d) Unilateral hydronephrosis
e) Ureteral dilation
The correct answer is A.
Urinary retention is most often caused by an anatomic obstruction to urine outflow. In men, this is often due to benign prostatic hypertrophy (BPH). Women have a variety of causes. The common manifestation of prolonged urinary retention is bilateral hydronephrosis due to urinary retention and pressure increases in the urinary system. The bladder is a very muscular organ. Increases in pressure do not cause bladder dilation (choice B), but rather, hypertrophy.
Bladder dyskinesis (choice C), like ventricular dyskinesis, would most likely be seen in an area of focal bladder injury. This most often results from external impingement on the bladder wall.
Unilateral hydronephrosis (choice D) is most often encountered in cases of ureteral obstruction in which only one kidney suffers from the increased pressure.
Ureteral dilation (choice E) would not be seen in urinary retention until very late in the course. It is an uncommon finding because most patients present to a physician prior to this late stage.