Ease Into Prep with a PANCE^® Question of the Day

The correct answer is A. Urinary retention is most often caused by an anatomic obstruction to urine outflow. In men, this is often caused by benign prostatic hyperplasia (BPH). Women have a variety of causes. The common manifestation of prolonged urinary retention is bilateral hydronephrosis caused by urinary retention and pressure increases in the urinary system. A large bladder mass would compress both distal ureters leading to inability of the kidneys to empty with resultant bilateral hydronephrosis.

The bladder is a very muscular organ. Increases in pressure do not cause bladder dilation (choice B) , but rather hypertrophy.

Bladder dyskinesis (choice C) , like ventricular dyskinesis, would most likely be seen in an area of focal bladder injury. This most often results from external impingement on the bladder wall.

Unilateral hydronephrosis (choice D) is most often encountered in cases of ureteral obstruction in which only one kidney suffers from the increased pressure.

Ureteral dilation (choice E) would not be seen in urinary retention until very late in the course. It is an uncommon finding because most patients present to a health care provider prior to this late stage.

PEARL: Bladder cancer generally presents in patients age >60. Think of bladder cancer in patients who have a history of smoking, urinary obstruction (which can lead to hydronephrosis), and/or hematuria. Bladder cancer is the fourth most common cancer in men and the ninth most common cancer in women. 90% of bladder cancer is transitional cell carcinoma.