Spontaneous Extraperitoneal Hematoma: An Unexpected Case of Dysuria and Urinary Retention in a 77-year-old Male

Urinary problems are common complaints in the Emergency Department and can present with any combination of lower urinary tract symptoms such as dysuria, hematuria, urgency, frequency, incontinence, or retention. We describe the case of a 77-year-old male who presented to the Emergency Department for five days of worsening dysuria. Two days prior, the patient was seen and evaluated for the same chief complaint, where he received intravenous antibiotics and was admitted to the hospital overnight for observation. The following day, the patient’s urinalysis and cultures were not consistent with a urinary tract infection (UTI) and was subsequently discharged without antibiotics. Due to the perplexing nature of the patient’s dysuria, we decided to obtain a CT of the abdomen and pelvis without contrast. The exact cause of the patient’s dysuria and urinary retention was then revealed to us: an extraperitoneal hematoma causing mass effect on the prostate, which in turn was compressing on and obstructing the urethra within the prostate