Urinary Retention in a Gender-Diverse Patient: A Learning Case

Author: Dr Dipesh Chhetri, Dr Himanshu Gul Mirani

Hospital: Midland Metropolitan University Hospital, Birmingham

Urinary Retention in a Gender-Diverse Patient: A Learning Case

A 53-year-old female presented to the Emergency Department with urinary retention (>500 mL post-void). She had multiple prior GP and ED visits for lower urinary tract symptoms and recurrent retention, treated empirically with antibiotics despite three sterile urine cultures. Point-of-care ultrasound revealed absence of a uterus, presence of a prostate gland, and a bladder diverticulum without hydronephrosis. On sensitive enquiry, she disclosed being a transwoman and previously felt unsafe revealing her gender identity. She was reassured, catheterised, and referred for outpatient imaging and urology review.

Learning Points:

Take an inclusive, non-judgemental history to create a safe space for transgender patients to disclose relevant information.

Understand anatomical and physiological variations in transgender individuals, including retained organs, for accurate diagnosis and management.

Avoid inappropriate treatments; sterile urine cultures in LUTS should prompt alternative diagnoses beyond infection.