male patient in 70s presents with left sided flank pain, no back pain, bedside USS to look at AA shows 2L urine, the patient has no urge to pass urine, not known to have any previous medical issues, no known prostate problems, renal CT, like USS shows dilation of L pelvix; a suspected stone - shown in Figure 5 may explain higher obstruction, but what would explain the painless urinary retention?

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1) diabetic vesicopathy, and neuropathy, can cause loss of bladder sensation, resulting in painless retention 2) spinal / neurological causes, like neurosyphilis, demyelinating diseases ,can cause painless retention. Cystoscopy and bladder monometry may throw some light. Diverticulae may indicate chronic retention .

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Non obstructive retesion of urine A. neurogenicbladder due nerve problem that interfere the signal between brain and bladder if the nerves are not working properly brain may not get any message that bladder is full. B Bladder muscles week to put pressure C Other causes Stroke Pelvic injury or trauma Impaired muscles and nerve function due to medication or anaesthesia Accident that caused injury to brain or spinal cord D. Diabetic vesicopathy or diabetic neuropathy

Neurogenic bladder

Spasm in bladder neck??

First relieve the retention by catheterization. Lab investigations for renal function. Only with long standing diabetes one can think of diabetic vesicopathy. History is inadequate to conclude. No investigation is useful without proper history and clinical examination findings.

Possibly diabetic with neurogenic bladder, spinal cord compression?

Post urethral valve

Catheterization may help to some extent.Intervention by Nephrologist will be needed

Catheterization and Cystoscopy to rule out obstruction -- stricture/ mass is worthwhile. Urine test -- routine and microscopy

I agree with Dr R S Rathor

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