SHM Converge Scientific Abstract ePoster Gallery-Severe Urinary Retention Resulting in Post-Obstructive Diuresis and Decompressive Hematuria

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This document describes two serious complications that can occur after relieving severe urinary obstruction: <strong>post-obstructive diuresis</strong> and <strong>decompressive hematuria</strong>.

<strong>Post-obstructive diuresis</strong> is defined as a urine output greater than <strong>200 mL/hour for 2 consecutive hours</strong> or <strong>more than 3 L in 24 hours</strong> after obstruction is relieved. It can cause major loss of salt and water, leading to <strong>severe dehydration, hypovolemic shock, electrolyte abnormalities</strong> (including hypo- or hypernatremia, hypokalemia, hypomagnesemia), <strong>metabolic acidosis</strong>, and even death. Monitoring should include <strong>vital signs, intake/output, serum electrolytes, and urine electrolytes</strong>.

<strong>Decompressive hematuria</strong> occurs when high pressure in the bladder is suddenly released, causing bleeding into the urinary tract. Risks include <strong>acute blood loss anemia, hemorrhagic shock, and death</strong>. Monitoring includes <strong>vital signs, urine color, and hemoglobin levels</strong>.

The case presented is a <strong>73-year-old man</strong> with heart failure with preserved ejection fraction who developed worsening edema, weight gain, dyspnea, urinary incontinence, and rising creatinine after starting furosemide. Imaging showed a <strong>massively distended bladder, severe bilateral hydroureteronephrosis, and enlarged prostate</strong>, consistent with urinary retention from <strong>BPH</strong>. After bladder decompression, he developed <strong>5.9 L of urine output</strong>, post-obstructive diuresis requiring fluids, blood pressure support, and electrolyte replacement, as well as severe hematuria.

He required <strong>4 units of packed red blood cells</strong>, continuous bladder irrigation, multiple cystoscopies for clot evacuation, and intravesical treatments. His edema resolved and kidney function improved from a creatinine of <strong>2.68 to 1.1 mg/dL</strong>. He was discharged with a Foley catheter and later transitioned to intermittent catheterization.

The key conclusion is that these complications are <strong>rare but potentially fatal</strong>, so patients with severe urinary obstruction need <strong>close inpatient monitoring and urology involvement</strong>.

Asset Subtitle

Jeanette Klamfoth Rosevear

Meta Tag

Author List Jeanette Klamfoth Rosevear, Joseph Kubeker, Kathryn Burtson

Category Clinical Vignettes

Concept Post-obstructive Diuresis

Concept Urinary Obstruction

Concept Decompressive Hematuria

Concept Urinary Retention

Concept Diuresis

Distinguished Non-Finalist

Presenter Organization Wright-Patterson AFB/ Wright State University

Presenting Author Jeanette Klamfoth Rosevear

Track Adult

Keywords

post-obstructive diuresis

decompressive hematuria

urinary obstruction

bladder decompression

electrolyte abnormalities

hypovolemic shock

hemorrhagic shock

benign prostatic hyperplasia

hydronephrosis

catheterization

Post-obstructive Diuresis

Urinary Obstruction

Decompressive Hematuria

Urinary Retention

Diuresis