Micturition Syncope Secondary to Urethral Obstruction with Multisystem Complications: A Case Report

Critically ill cases of micturition syncope secondary to urethral obstruction with multiple systemic complications are uncommon. A 61-year-old man developed dysuria and sustained high intravesical pressure after ureteroscopic lithotripsy because of postoperative urethral obstruction. Pressure-induced urinary incontinence and syncope subsequently occurred, followed by gross hematuria. The clinical course was complicated by mixed pulmonary infection, severe electrolyte disturbances, rhabdomyolysis, right hydronephrosis, liver injury, and stress-related gastrointestinal bleeding. Micturition syncope was considered the most likely clinical diagnosis based on the complete clinical sequence of dysuria, sustained high intravesical pressure, urinary incontinence, and syncope, together with urinary tract imaging findings and systematic exclusion of cardiogenic, central nervous system, and metabolic causes of altered consciousness. Management included airway-protective mechanical ventilation, staged hemostatic and transfusion support, microbiology-guided antimicrobial therapy, staged fluid replacement and pharmacological correction of internal milieu disturbances, and coordinated multiorgan supportive care. After intensive care treatment, the patient was transferred to a general ward. No recurrence of syncope or hematuria was observed during the 1-month follow-up. This case highlights the importance of early recognition of multiorgan injury and individualized, coordinated management in severe micturition syncope associated with postoperative bladder hypertension and urinary incontinence.