Idiopathic giant atonic bladder (6000 mL in volume) that is present for 15 years with no urinary symptoms

Abstract

Urinary retention is common in patients with neurologic disorders. We present a case of asymptomatic idiopathic giant bladder from which 6000 mL urine was drained. This is the largest volume of bladder that we found in the literature. T he urinary bladder is an unusual structure in that it is autonomically innervated yet functions under voluntary control. Although it is well-known that patients with a variety of neurological diseases suffer disturbances of continence and micturition, the precise ways in which these disorders affect the neurophysiological mechanisms of the bladder are poorly understood. Indeed, when a patient presents with urinary dysfunction, it is often difficult to be certain whether there is a neurological basis for the symptoms, or whether they are purely the result of a local abnormality, such as bladder outflow obstruction. 1 We present a case of giant bladder from which 6000 mL urine was drained via a urinary catheter. This is the largest volume of bladder that we found in the literature. The patient was asymptomatic except for abdominal distention, and we could not find any disorder that might be the cause of this massive bladder distention. Case reportA 62-year-old male was admitted to our hospital with the complaint of rectal bleeding after defecation for 2 months. He also lost 3 kilograms of weight during this period. On physical examination, significant abdominal distention was detected (Fig. 1). From the patient's history, we learned that he had a gradual increase of this distension for 15 years. He had no urinary complaints. A vegetative and polipoid mass was detected in the rectum 8 to 10 cm from the anal verge by rectoscopy and biopsies were taken. After having the histopathologic diagnosis as adenocarcinoma of the rectum, the patient underwent surgical operation. All preoperative laboratory tests, including urea and creatinine, were within normal values. Preoperative ultrasonography revealed a 24 × 23-cm cystic mass filling abdomen and pelvis. Computerized tomography (CT) also confirmed a 24 × 23 × 13-cm cystic mass with a delicate capsule and firm septations that supposedly originated from the mesentery (Fig. 2). The bladder could not be visualized probably due to inadequate filling with radiopaque substance. The rectal wall was thick along 5 cm of length. In the operating room, a urinary catheter was inserted for urinary outflow follow-up. After catheterization, 6000 mL of urine was drained, and the abdominal distention disappeared (Fig. 3). Laparotomy was performed and it was seen that there was no cystic mass in the abdominal cavity except for atonic bladder; so we decided that the cause of abdominal distention was atonic bladder, not another cystic mass (Fig. 4). Low anterior resection was performed. The tumour did not invade surrounding tissues and it was easily removed. Anastomosis was performed by stapler. A giant atonic bladder was detected, and a urologist was consulted during surgery. Since the patient had no obvious urinary complaints until the operation, he ...

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Giant urinary bladder (11 000 mL in volume) with bilateral lower limb oedema: an unusual cause of inferior vena cava obstruction

“…Yücel et al 1 reported a case of GB due to diabetic neuropathy with a capacity of 10 500 mL, the largest reported volume in the literature to date 1. Ay et al 2 also presented a 6000 mL capacity asymptomatic idiopathic atonic bladder in 2013. The present case has the largest volume of bladder (11 000 mL) reported.…”