Disclosures: Dana W. Miller, MD: No financial relationships or conflicts of interest

Case Description: A patient admitted for progressive lower extremity weakness, found to have severe T11-T12 spinal stenosis with myelomalacia, developed acute kidney injury (AKI) after a T10/11 decompressive laminectomy and fusion. A Foley catheter was placed due to inability to void, with placement complicated by hematuria. His creatinine continued to rise from a baseline of 0.80 to 5.29, though at this time his renal ultrasound was normal, and the AKI was determined to be multifactorial, possibly secondary to ATN. His creatinine stabilized between 2.0-4.0, and he was discharged to our inpatient rehabilitation hospital, where he was noted to have a firm, distended bladder on physical exam. He was subsequently straight catheterized for 1750ml. Foley catheter was replaced, which initially drained clear urine but again developed hematuria and clots. Over the next several hours urine output increased to 750-850ml/hour, for a total urine output of >12L over the next 24 hours.

Setting: Inpatient Rehabilitation Hospital Associated with Academic Tertiary Care Hospital

Patient: 78 year old male with L1 Incomplete Paraplegia

Assessment/Results: After Foley catheter replacement, his creatinine improved from 2.79 to 0.81 within 24 hours, and repeat renal ultrasound showed bilateral hydronephrosis. He ultimately had post-obstructive diuresis for six days, and required significant IV fluid replacement due to large net negative fluid status and electrolyte loss.

Discussion: Acute urinary retention can be difficult to diagnose in patients with impaired sensation and neurogenic bladder, which can lead to incomplete bladder decompression and a delay in diagnosis and treatment. Subsequent post-obstructive diuresis can be potentially fatal if not identified and treated.

Conclusion: Post-obstructive diuresis is an important complication of neurogenic bladder that providers need to be aware of when treating patients with spinal cord injuries, to ensure appropriate monitoring and treatment of potential bladder obstruction and its sequela.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/post-obstructive-diuresis-after-partial-foley-catheter-obstruction-in-incomplete-paraplegia-with-neurogenic-bladder-a-case-report/