A case of sudden, painless, and persistent urinary incontinence

Urinary incontinence is not a common emergency department (ED) complaint, and it is hard to imagine that a case involving this complaint could turn out to be interesting. We report the case of a patient who presented with the complaint of sudden onset of painless urinary incontinence for 1 day, who had an unexpected diagnosis.

To describe a case of incontinence with an unexpected diagnosis and to review the various causes of incontinence.

A 52-year-old woman with a history of kidney stones recently treated with lithotripsy, nephrostomy tubes, and ureteral stents, presented to the ED complaining of new-onset incontinence. The patient had awakened on the morning of presentation with urinary incontinence that persisted throughout the day. On examination she had normal vital signs, and other than a functioning nephrostomy tube, she had a normal examination. In addition to a urinalysis, a KUB (kidney, ureter, and bladder) X-ray study was performed, which showed that her recently placed right ureteral stent had migrated from its original location into the urethra. The stent was found by the urologist protruding from the urethral meatus and removed without difficulty. The patient's incontinence resolved immediately after the stent was removed.

Emergency physicians frequently see patients with ureteral stents, but may not be aware of how frequently those stents can migrate or malfunction. Our experience suggests that radiologic determination of stent location may be helpful in patients who present with new-onset stress or overflow incontinence.