A previously well, independent woman in her 90s presented to hospital with two days of worsening confusion, new onset urinary incontinence, and increased urinary frequency. Two days before that, she had been started on nitrofurantoin for urinary tract infection (UTI) by her GP.

She had a history of hypertension, osteoporosis, mild dementia, chronic obstructive pulmonary disease, peripheral vascular disease, chronic renal failure, and several transient ischaemic attacks.

Discomfort on palpation of the lower abdomen, no signs of peritonism, and a palpable large suprapubic mass attributed to urinary retention prompted urinary catheterisation, which produced only 100 mL of urine. She underwent a portable bedside bladder scan, which showed urinary retention with a post void residual urine (PVRU) volume of almost 1 L.

Three further attempts were made at urinary catheterisation, with only small amounts of urine drained. Urgent imaging with a pelvic ultrasound showed an underfilled bladder with 67 mL of urine, compressed by a large septated pelvic cyst that extended to the level of the umbilicus. …

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