Bladder Outflow Obstruction: An Unusual Presentation Of Mucocele Of The Appendix

摘要

Bladder outflow obstruction in elderly males usually results from an intrinsic narrowing at the level of bladder neck, prostate or the urethra. We report a case where obstruction to the bladder outflow resulted from an extrinsic compression by an appendicular mucocele, an unusual mode of presentation of this pathological entity. Introduction Bladder outflow obstruction in males usually results from an intrinsic obstruction of the lower urinary tract, in the region of the prostatic or peno-bulbar urethra. Extrinsic compression leading to outflow obstruction can occur in women but not seen frequently in men. This case report illustrates how a pelvic mass can lead to bladder outflow obstruction by extrinsic compression. Case Report A 62 year old man presented with moderate lower urinary tract symptoms (LUTS), a small benign feeling prostate, a PSA of 1.7 and microscopic haematuria. Uroflowmetry showed a maximum flow rate of 5.4 ml/sec for a voided volume of 305 ml and a postvoid residual of 328 cc suggestive of bladder outflow obstruction. The only abnormalities on routine blood tests were an ESR of 36 and a CRP of 75. Urine cytology and microscopy was clear. The patient was put on the waiting list for cystoscopy and an ultrasound scan was requested. At cystoscopy there was no urethral stricture seen and residual urine of 300 ml was present. The bladder neck was occlusive, displaced anteriorly and the entire right lateral wall and dome was pushed to the left by an extrinsic mass. The mass extended from the umbilicus towards the pelvis and felt cystic on bimanual examination. The ultrasound scan, revealed mild right ureterohydronephrosis and a heterogeneous mass 16x8x8 cm in size arising behind the bladder. Subsequent contrast CT scan showed a large cystic structure within the pelvis continuous with the bladder, most likely to be a large bladder diverticulum arising from the fundus (FIG I).