Long-Term Respiratory Care Division, Herzog Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel.
Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
Am J Case Rep. 2022 Oct 27;23:e937318. doi: 10.12659/AJCR.937318.
BACKGROUND Automated bladder scanning has become a principal tool in the assessment and management of chronically debilitated patients residing in skilled nursing facilities, hospices, and acute inpatient settings. To a large extent, the bladder scan, generally performed by nursing staff, has replaced physical examination while addressing the differential diagnoses of anuria or voiding disturbances that require consideration of urinary catheterization. Health care providers can quickly master this easily performed technique, and currently, due to confidence in the bladder scan finding, physical examination with suprapubic palpation and percussion may be carelessly omitted. The case description presented here illustrates how not performing a physical examination can lead to misdiagnosis caused by misinterpretation of bladder scan findings. CASE REPORT A 66-year-old, quadriparetic, chronically ventilated female patient with achondroplasia underwent repeated hospital referrals and bladder catheterizations for presumed flaccid, neurogenic bladder with urinary retention. This postulated diagnosis was based on occasional reports of urinary catheter obstruction as well as on automated bladder scanning indicating a markedly distended bladder. However, the bladder could not be drained by insertion of urinary catheters. Eventually, a proper physical examination excluded the presence of suprapubic fullness compatible with distended bladder and contradicting bladder scan findings, prompting re-examining an overlooked evaluation of computed tomography that reported a huge ovarian cyst. The patient was found to have intact voiding capabilities and is now weaned from the catheter. CONCLUSIONS This case and the literature review underscore drawbacks in automated bladder scanning. This technique should be used as an adjunctive measure rather than a replacement for a physical examination in the evaluation of voiding disturbances, especially when there are discrepancies between bladder scan findings and the volume of urine drained by catheterization.
自动化膀胱扫描已成为评估和管理长期虚弱患者的主要工具，这些患者居住在熟练护理设施、临终关怀机构和急性住院环境中。在很大程度上，由护理人员进行的膀胱扫描已经取代了体格检查，用于解决需要考虑导尿的无尿或排尿障碍的鉴别诊断。医疗保健提供者可以快速掌握这种易于操作的技术，目前，由于对膀胱扫描结果的信心，体格检查（包括耻骨上触诊和叩诊）可能会被粗心地省略。本文介绍的病例说明了不进行体格检查如何导致由于对膀胱扫描结果的误解而导致误诊。
一位 66 岁的四肢瘫痪、长期使用呼吸机的女性患者，患有软骨发育不全症，因疑似弛缓性、神经性膀胱伴尿潴留而多次转院和进行膀胱导管插入术。这个推测的诊断是基于偶尔报告的导尿管阻塞以及自动化膀胱扫描显示明显膨胀的膀胱。然而，插入导尿管无法排空膀胱。最终，适当的体格检查排除了耻骨上饱满的情况，这与膨胀的膀胱和膀胱扫描结果相矛盾，促使重新检查被忽视的计算机断层扫描评估，报告了一个巨大的卵巢囊肿。发现患者有完整的排尿能力，现已从导管中逐渐脱离。
本病例和文献回顾强调了自动化膀胱扫描的缺点。该技术应作为辅助措施，而不是在评估排尿障碍时替代体格检查，特别是当膀胱扫描结果与导管排空的尿量存在差异时。
