Posing as Ascites: A Case Report on Neurogenic Lower Urinary Tract Dysfunction.

Area of Science:

• Neuro-urology
• Neurology
• Urology

Background:

• Lower urinary tract dysfunction (LUTD) is often underdiagnosed, particularly neurogenic causes without apparent neurological deficits.
• Evaluating spinal cord segments controlling bladder and sphincter function is crucial for identifying neurogenic etiology.

Observation:

• A 52-year-old female presented with abdominal pain, urinary straining, slow stream, and stress incontinence after hospitalization for constitutional syndrome and falls.
• Physical exam revealed a fluid wave sign; CT showed bladder hyperdistention and an L5 compression fracture.
• Neuro-urological examination indicated diminished anal sphincter tone, voluntary contraction, and absent left anal reflex, consistent with lower motor neuron bladder dysfunction.

Findings:

• Urodynamic studies supported a diagnosis of lower motor neuron bladder dysfunction.
• Clinical findings were compatible with damage to sacral nerve roots (S2-S4).

Implications:

• This case highlights the importance of a complete neuro-urological examination for diagnosing unexplained bladder dysfunction.
• Routine integration of sacral nerve segment evaluation into neurological assessments is recommended for identifying neurogenic LUTD.