卓孟德

聖安中醫診所

St. Anne’s Chinese Medicine Clinic

 

A 52 years old Foley dependent male with history of hemorrhage stroke about 2 years ago, presented with conscious loss and urine retention then presented with right side hemiparesis aphasia and urine retention after urgent operation. Cystometrogram showed detrusor areflexia ( acontractile) at that time, and prostate size was 25ml, Trans-abdominal ultrasound showed no obvious middle lobe enlargement or other abnormal, Foley with intermittent clamping training was suggested at that time. However, after 2 years rehabilitation, right side muscle power improved, but still no sensation for bladder fullness, and thus Foley indwelling currently.

Guanyuan ( RN4 or CV4) and Qihai ( RN6 or CV 6) were the acupuncture points chose for initial treatment, with Foley training record was also suggested, Acupuncture treatment on ever Monday, Wednesday, and Friday morning, and retaining needles for 15 minutes. All Foley training record was listed in Table. 1. At first week of treatment, no fullness sensation even if 4 hours Foley clamping with urine amount up to 600ml. However, low abdominal soreness and dullness was complained. At the end of 2nd week treatment, bladder fullness sensation was first experienced after clamp Foley catheter for 3.5 hrs with bladder urine amount 550 ml, then gradually improved. At the 3^rd week of treatment, treatment interval was lengthening to every Monday and Thursday, twice a week. After complete three weeks of treatment, removal of Foley was discussed with patient under stationary Foley training responses. Foley catheter was then removed on fourth Monday morning after acupuncture treatment, and educated his main caregiver the method of intermittent catheterization, after success for the first void, and residual urine 150 ml, he left the clinic without Foley. However, frequency up to 12 times during daytime and nocturia up to 4~5 times per night with poor sleep quality was complained for ther first 2 days after removal of Foley. Choice to acupuncture point was switched to Baliao (BL31 Shangliao, BL32 Ciliao, BL33 Zhongliao, And BL34 Xialiao) and Weizhong (BL40), Sanyinjiao(SP6). Frequency and Nocturia improved after first treatment, and after another two times of treatment, Nocturia decrease to only 1 time or none. Voiding diary was summerized and listed on Table.2. Currently under smooth voiding condition. Considering referral for a comprehensive urodynamic study. For re-evaluation