BACKGROUND
Massive urinary retention is an emergency diagnosis that has been rarely reported in the literature. Complications include bladder rupture, acute renal failure, ascending urinary infection, and shock. Although typically presenting as difficulty voiding, subtle signs can include dyspnea and upper abdominal discomfort, as seen in our case, potentially delaying definitive diagnosis and treatment.
CASE REPORT
We describe massive urinary retention in a 58-year-old man presenting to the emergency department with shortness of breath and upper abdominal discomfort. His symptoms were initially concerning for complications from metastatic pancreatic cancer. Examination revealed dyspnea and diffuse abdominal tenderness with mild distention. Computed tomography imaging revealed massive distention of the urinary bladder with the dome extending above the umbilicus. After consultation with Urology, foley catheterization was performed with return of 3.8 liters of urine. The patient was observed following decompression without hemodynamic instability or hematuria. Given his history of obstructive benign prostatic hypertrophy status after transurethral aquablation, he was discharged with an indwelling catheter. In the outpatient setting, a trial of void was unsuccessful, and he remained dependent on an indwelling catheter at the last documented follow-up.
CONCLUSIONS
Clinicians evaluating patients for dyspnea and abdominal discomfort should be alert to possible urologic causes, including massive bladder dilation from retention. Our patient’s dyspnea and upper abdominal discomfort improved promptly after bladder decompression, supporting an association with massive bladder distention. A cephalad mass effect of the distended bladder on intra-abdominal structures and the diaphragm is a plausible but unconfirmed explanation, as no imaging or physiologic study directly demonstrated this mechanism. Prompt recognition and management along with appropriate consultation are necessary to mitigate risk of adverse outcomes in this urologic emergency.

Keywords: Emergency Medicine; Urinary Retention; Urinary Catheterization