What is the best course of action for a female patient with a benign bladder polyp (polypoid lesion) and significant bladder distension (urinary retention)?

From the Guidelines

The female patient with a benign bladder polyp and significant urinary retention should be sent to the urologist for immediate catheterization to relieve the bladder distension, followed by complete transurethral resection of the polyp. The presence of a 1.2 x 0.7 cm polyp in the bladder, along with significant distension (volume of 771 ml) and smooth, regular walls, suggests a benign polyp as the most likely cause, and the patient's symptoms of urinary retention necessitate prompt intervention to prevent complications like renal damage or bladder rupture. According to the most recent guidelines, such as the one from the Journal of the American College of Radiology 1, initial evaluation of patients with urinary dysfunction may include physical examination, urinalysis, urinary stress testing, voiding diary, and urodynamic testing with cystourethrography. However, given the patient's significant bladder distension and suspected benign polyp, immediate catheterization and subsequent transurethral resection of the polyp are the most appropriate course of action, as this approach addresses both the immediate concern of urinary retention and definitively treats the underlying polyp, which may be causing obstruction of the bladder outlet or urethra. The use of alpha-blockers, as suggested in the 2003 AUA guideline on management of benign prostatic hyperplasia 1, may not be directly applicable to this female patient, and the primary focus should be on relieving the urinary retention and removing the polyp. Post-procedure, the patient should receive prophylactic antibiotics to prevent urinary tract infection, and follow-up cystoscopy is recommended to ensure complete removal and absence of recurrence. Key considerations in the management of this patient include:

• Immediate catheterization to relieve bladder distension
• Complete transurethral resection of the polyp
• Pathological examination of the resected tissue to confirm benignity
• Prophylactic antibiotics to prevent urinary tract infection
• Follow-up cystoscopy to ensure complete removal and absence of recurrence.

From the Research

Diagnosis and Treatment

• The presence of a benign bladder polyp and significant bladder distension in a female patient suggests that the polyp may be obstructing urine flow, leading to distension 2.
• The patient's symptoms and ultrasound findings are consistent with a diagnosis of urinary retention, which can be caused by a variety of factors, including benign bladder polyps 3, 4.

Management and Referral

• The management of female urinary retention should focus on identifying and treating reversible causes, and may involve catheterization, ultrasound, and referral to a urologist 3.
• Patients with urinary retention should be evaluated for underlying abnormalities, such as detrusor failure or outlet obstruction, and treated accordingly 3, 4.
• Referral to a urologist with an interest in bladder dysfunction may be necessary for further evaluation and treatment, particularly if the patient fails to void after catheter removal or has apparently idiopathic retention 3.

Diagnostic Tools

• Ultrasound is a useful diagnostic tool for detecting bladder polyps and urinary retention, and can be used to guide treatment decisions 2, 5.
• Bladder ultrasound is a safer alternative to catheterization for diagnosing urinary retention, and can be used to monitor bladder volume and guide treatment 5.