Poster
157
(#157) Acute Hydronephrosis in the Setting of Clozapine-Induced Urinary Retention: A Case Report
Psych Congress 2025
Abstract: Clozapine remains the gold standard for treatment-refractory schizophrenia due to its superior efficacy amongst other antipsychotics. However, it is associated with many adverse drug reactions, most noticeably sedation, sialorrhea, and constipation. These side effects are well-known and expected amongst physicians starting a patient on clozapine. This is primarily due to the anticholinergic side effects of clozapine, through its action on muscarinic acetylcholine receptors, particularly the M1 receptor subtype. However, urinary retention is another adverse drug reaction of clozapine, rare and less well-known. Urinary retention is often suspected to result from benign prostatic hyperplasia or prostate cancer, as these are among the most common underlying causes. Without prompt management, urinary retention can quickly progress to kidney disease and possibly even renal failure in severe instances. Given this, it becomes even more crucial for physicians to be aware of this rare side effect of clozapine.
Urinary retention can lead to patient discomfort, medication nonadherence, and psychotic relapse. Despite its importance, clozapine-induced urinary retention is sparsely described in the literature, resulting in limited awareness among clinicians. In this report, we describe the case of a 57-year-old schizoaffective male, managed on clozapine, who was hospitalized for delirium, urinary retention, and bilateral hydronephrosis and eventually successfully treated with bethanechol. We therefore aimed to describe a case of clozapine-induced urinary retention and effective treatment to guide management for clinicians and patients in the future. This is important to psychiatrists, as recognizing this side effect early can prevent hospitalization and renal failure in patients with treatment-refractory schizophrenia.
Short Description: This poster discusses the case of a schizoaffective patient who developed acute hydronephrosis and urinary retention as a result of clozapine. The patient history, physical exam findings, lab and imaging results, and hospital course is discussed. There is also a discussion on the anticholinergic properties of clozapine, contributing to the importance of this case.
Name of Sponsoring Organization(s): N/A
Urinary retention can lead to patient discomfort, medication nonadherence, and psychotic relapse. Despite its importance, clozapine-induced urinary retention is sparsely described in the literature, resulting in limited awareness among clinicians. In this report, we describe the case of a 57-year-old schizoaffective male, managed on clozapine, who was hospitalized for delirium, urinary retention, and bilateral hydronephrosis and eventually successfully treated with bethanechol. We therefore aimed to describe a case of clozapine-induced urinary retention and effective treatment to guide management for clinicians and patients in the future. This is important to psychiatrists, as recognizing this side effect early can prevent hospitalization and renal failure in patients with treatment-refractory schizophrenia.
Short Description: This poster discusses the case of a schizoaffective patient who developed acute hydronephrosis and urinary retention as a result of clozapine. The patient history, physical exam findings, lab and imaging results, and hospital course is discussed. There is also a discussion on the anticholinergic properties of clozapine, contributing to the importance of this case.
Name of Sponsoring Organization(s): N/A
