Severe Urinary Retention Resulting in Extreme Post-obstructive Diuresis and Decompressive Hematuria

Post-obstructive diuresis and decompressive hematuria are rare but potentially serious complications of severe urinary retention. This is a case report of a 73-year-old patient with undiagnosed severe large-volume urinary retention who developed extreme cases of both complications after presenting with progressive weight gain, lower extremity edema, worsening dyspnea, and new-onset urinary incontinence. Upon further evaluation, the patient was determined to have acute renal failure, bilateral hydroureteronephrosis, a severely distended urinary bladder, and an enlarged prostate. Foley catheterization produced 5.9 L of urinary output with initial placement. He required prolonged hospitalization for hemodynamic monitoring requiring fluid resuscitation, serial electrolyte monitoring requiring repletion, acute blood loss anemia requiring four units of red blood cell transfusion, continuous bladder irrigation, three cystoscopies under anesthesia, and intravesicular fibrinolysis inhibitor instillations. This case illustrates an extreme severity of post-obstructive diuresis and decompressive hematuria in chronic urinary retention that has not been previously described in the literature.