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Pediatria Polska - Polish Journal of Paediatrics
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2/2024
vol. 99
 
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abstract:
Case report

Acute urinary retention in a 14-year-old girl – diagnostic and therapeutic difficulties when initial therapy fails

Michał Janusz Łyszkowicz
1
,
Małgorzata Barbara Stańczyk
2, 3
,
Marek Krakós
4
,
Łukasz Przysło
5
,
Marcin Tkaczyk
2, 3

  1. Medical University of Białystok, Białystok, Poland
  2. Department of Paediatrics, Immunology, and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
  3. Department of Pediatrics, Nephrology and Immunology, Medical University of Łódź, Łódź, Poland
  4. Department of Interventional Paediatrics/Paediatric Surgery/Paediatric Urology, Janusz Korczak Paediatric Centre, Regional Multi-Specialist Centre for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital, Łódź, Poland
  5. Department of Developmental Neurology and Epileptology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
Pediatr Pol 2024; 99 (2): 153-157
DOI: https://doi.org/10.5114/polp.2024.140282
Online publish date: 2024/06/06
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Acute urinary retention is rare in children and has various causes, but in 10% of cases has unclear aetiology. It is more common in boys and is often associated with urinary tract inflammation or mechanical obstruction. A 14-year-old girl presented with urinary retention preceded by haematuria and abdominal pain. Catheterisation drained 900 ml of urine, and symptoms initially subsided after taking α-blockers and oxybutynin. However, urinary retention reoccurred and persisted. Cystometry demonstrated bladder insensitivity, decreased detrusor activity, and increased sphincter tone. Suprapubic urinary diversion was performed. Neurological and magnetic resonance imaging examinations were normal, but cerebrospinal fluid showed IgG antibodies that reacted with sulfatide antigens. Immunosuppressive treatment was ineffective. Eventually administration of distigmine and baclofen permanently restored bladder function within a week. Persistent urinary retention is very distressing. Prompt diagnosis is possible, but managing idiopathic cases poses challenges, requiring a multidisciplinary approach. Evaluation based on knowledge of organ innervation is crucial.
keywords:

adolescent, urinary retention, baclofen, neurogenic urinary bladder, distigmine