Department of Urology, Countess of Chester Hospital, Chester, UK.
A 64-year-old man presented with month of gradual-onset left legswelling and lower urinary tract symptoms including enuresis, frequency and poor stream. He was initially treated for suspected cellulitis, however, he returned ;weeks later with persistence of his symptoms.
Routine biochemical investigation revealed renal failure (Cr 623, Ur 29.9) and hyperkalaemia (K 7.2). Abdominal examination revealed a distended urinary bladder and an ultrasound scan revealed hydronephrosis, confirming the diagnosis of chronic high-pressure urinary retention. A urinary catheter was passed that initially drained 1.5 litre of clear urine. Shortly after insertion, this became heavily blood stained. A CT kidney ureter bladder (CTKUB) revealed a large mass behind the bladder thought to represent either an abscess or tumour. Cystoscopic correlation showed this to be a large, narrow-necked bladder diverticulum tensely distended with clot. Following successful clot evacuation and decompression of the bladder the legswelling resolved and renal function improved.