Point-of-Care Ultrasound in Acute Urinary Retention Revealing Post-Renal Acute Kidney Injury Secondary to Bladder Malignancy: A Case Report
Dr Himanshu Gul Mirani
Case Presentation:
A man in his seventies presented to the emergency department with an 18-hour history of inability to pass urine effectively, characterized by a sensation of incomplete voiding and dribbling of frank haematuria rather than complete urinary retention. He reported progressive lower urinary tract symptoms over preceding weeks, particularly a persistent feeling of incomplete bladder emptying. He denied prior episodes of haematuria, acute urinary retention, weight loss, night sweats, or other constitutional symptoms. There was no history of recent urinary tract instrumentation or infection.
On examination, he appeared uncomfortable with a persistent urge to void but was unable to initiate a normal urinary stream. Vital signs were stable. Abdominal examination revealed a mildly tender, distended suprapubic region suggestive of significant bladder filling. He was otherwise systemically well. The presentation raised concern for clot retention causing functional outflow obstruction in the context of haematuria, warranting urgent further evaluation.
Images showing hydronephrosis and clot within the urinary bladder
Management and Outcome:
Point-of-care ultrasound (POCUS) was performed at the bedside. This demonstrated a markedly distended bladder containing heterogeneous echogenic material consistent with extensive clot burden. Bilateral hydronephrosis was also identified, raising concern for obstructive uropathy. Visualization of the bladder wall was limited due to intravesical clot, and an underlying lesion could not be excluded.
Laboratory investigations subsequently revealed acute kidney injury stage 3, supporting a diagnosis of post-renal obstruction. Formal imaging following initial stabilization confirmed the presence of a bladder malignancy, identified as the underlying cause of haematuria, clot retention, and obstructive uropathy.
Urology was urgently consulted. A three-way urinary catheter was inserted, and bladder irrigation was performed to evacuate clots and relieve obstruction. This resulted in partial decompression of the bladder. The patient was admitted for ongoing management, including renal function monitoring and further oncological evaluation.
Key Learnings and Points:
Point-of-care ultrasound is a rapid and effective tool for evaluating acute urinary retention in the emergency setting.
Identification of hydronephrosis on POCUS should prompt consideration of post-renal causes of acute kidney injury.
Visualization of intravesical clots can obscure underlying pathology, but should raise suspicion for significant bleeding sources, including malignancy.
Early use of POCUS facilitates timely escalation to specialist care and targeted interventions such as catheterization and bladder irrigation.
Integrating bedside ultrasound into routine assessment of urinary retention enhances diagnostic accuracy and supports early, cause-directed management.