Abstract: Venous Obstruction Due to a Distended Urinary Bladder

Jonathan M. Evans, MD, Tomás P. Owens, Jr., MD, Douglas M. Zerbe, MD, and Charles H. Rohren, MD. "Venous Obstructions Due to a Distended Urinary Bladder." Mayo Clinic Proceedings 70 (1995): 1077-79.

Objectives:
* To draw attention to the role of bladder distention in causing venous obstruction, a condition that may be confused clinically with deep venous thrombosis or congestive heart failure. The case of a 73-year-old man is described in detail, and fifteen other cases of venous obstruction due to urinary retention are also reviewed.

Conclusions:
* Bladder distension in men is often caused by enlargement of the prostate.
* Bladder decompression by catheterization results in a prompt resolution of the symptoms of venous obstruction. Some patients subsequently require long-term catheterization, however, because their bladder tone never completely returns to normal.
* Venous obstruction resulting from bladder distension is manifested in lower extremity edema (the swelling of the legs). This condition can lead to the incorrect diagnosis of deep venous thrombosis, or congestive heart failure, resulting in the unnecessary prescription of anticoagulant therapy, with its attendant risks.
* Physical examination alone can often identify the presence of a distended bladder. In the case of the 73-year-old man, "this physical finding, however, may have been overlooked, perhaps because physicans do not routinely attempt to palpate the bladder as part of a general examination or may not be able to identify the bladder accurately by palpation and because bladder enlargement in our patient was not suspected initially."
* "Leg edema due to a distended bladder has been reported infrequently, although its occurrence is most likely underrecognized. The occurrence of a distended bladder is common. Why venous obstructions does not occur more often as a result is unknown, however."
* In addition to other typical symptoms of urinary retention, a distended bladder can be expressed as constipation and rectal tenesmus due to the compression of the rectum, unilateral sciatic pain resulting from nerve compression, spontaneous bladder rupture, and acute confusion.
* "Patients with acute urinary retention tend to be elderly, and because of their advanced age (along with the possibility of a superimposed acute confusional state). They may have difficulty recognizing or expressing their symptoms. Thus, clinicians must be alert to the possibility of atypical manifestations and suspect this reversible condition."

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