Posing as Ascites: A Case Report on Neurogenic Lower Urinary Tract Dysfunction

Lower urinary tract dysfunction (LUTD) is a frequently neglected and underdiagnosed condition, especially in cases of neurogenic etiology where no other neurological deficits are present. The evaluation of the integrity of the spinal cord segments responsible for the neurophysiologic control of the bladder and sphincters is fundamental for correctly establishing a neurogenic etiology. We present the case of a 52-year-old female complaining of abdominal pain, new onset of urinary straining, a slow/intermittent stream, and stress incontinence, following inpatient admission for a history of constitutional syndrome and falls. A fluid wave sign was observed on physical examination. An abdominal CT scan showed bladder hyperdistention and an L5 body compression fracture. A urinary catheter was placed, draining 2,000 mL of urine. On neuro-urological examination, diminished anal sphincter tone, diminished voluntary anal contraction, and absent left anal reflex were noted. Findings on the urodynamic study further favored the diagnosis of lower motor neuron bladder dysfunction. This case report demonstrates how the neurologic examination of the sacral segments S2-S4 allowed the diagnosis and subsequent management of an initially unexplained bladder dysfunction, as our clinical findings were compatible with damage to the sacral roots. The complete neuro-urological examination is fundamental for correctly determining the neurogenic etiology of LUTD and should be routinely integrated into the neurological evaluation.