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BACKGROUND
A 52-year-old man presents to the emergency department (ED) because of dribbling incontinence that started 5 days ago. The patient reports a constant, slow leakage of urine throughout the day and night. He uses 4-5 diapers per day and 1-2 diapers per night. He denies having fevers, chills, or hematuria. He reports having mild right flank pain and lower abdominal discomfort while walking and standing. He otherwise denies having chronic medical conditions and does not take any regular medications.
The patient has a long-standing history of recurrent urolithiasis and has undergone several endoscopic procedures. The last procedure was done 3 weeks ago, when cystoscopy was performed and a JJ ureteral stent was placed to manage a symptomatic 2 X 3-mm stone that was obstructing the right distal ureter (see Image 1). Symptoms at that time included right renal colic, anorexia, nausea, and vomiting. The patient was discharged home, and cystoscopy, stent removal, and CT was scheduled for 6 weeks later. He passed a 3-mm stone 1 week after stent placement.
On physical examination, the patient appears well and has normal vital signs. Urologic examination reveals a slow dribbling of urine without a foul smell or discoloration. Genital, abdominal, and neurologic examinations yield unremarkable findings. Urinalysis, urine cultures, CBCs, and serum electrolyte and creatinine levels are all within normal limits. A kidneys, ureters, and bladder (KUB) radiograph is obtained (see Image 2).
What is the diagnosis?
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Hint
An attempt by the emergency department nurse to insert a 16 French Foley catheter failed because of encountered resistance. |
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Author:
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Andrei Botnaru, MD,
Department of Urology,
Emory University,
Atlanta, GA
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eMedicine Editor:
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Erik D. Schraga, MD,
Department of Emergency Medicine,
Kaiser
Permanente,
Santa Clara Medical Center, Calif
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