薦部帶狀皰疹導致急性尿滯留---病例報告與文獻回顧
陳韋志1,2、李建達1,3、吳育欣4、賴慧貞3,5
1 衛生福利部豐原醫院泌尿科; 2 國立中興大學生命科學系; 3 中台科技大學;
4 衛生福利部豐原醫院皮膚科; 5 衛生福利部豐原醫院復健科;
Acute Urinary Retention Associated with Sacral Herpes Zoster Infection
--- A Case Report and Literature Review
Wei-Chih Chen 1,2, Jane-Dar Lee 1,3, Yu-Hsin Wu 4, Huey-Jen Lay5
1 The Department of Urology, Feng-Yuan Hospital, Ministry of Health and Welfare,
Taichung, Taiwan; 2 The Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan; 3 The Central Taiwan University of Science and Technology, Taichung, Taiwan; 4 The Department of Dermatology, Feng-Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan; 5 The Department of Rehabilitation, Feng-Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
Case presentation: An 88-year-old woman was brought to urological outpatient department due to dribbling incontinence for seven days. The symptoms of intermittent slow leakage of urine and difficult voiding with urinary frequency were also noted recently. There is also a history of constipation and lower abdominal discomfort during the last week. She denies having fevers, chills, nausea, vomiting, or diarrhea. There is no history of hematuria or stone disease. Her medical history includes hypertension and asthma under treatment. In the one-week period before presentation, she states that topical acyclovir cream is administrated due to herpes zoster infection.
On physical examination, the patient is a well-oriented elderly woman in no acute distress and has normal vital signs. Her systemic examination is essentially unremarkable. On abdominal examination, she has a palpably full urinary bladder that is midway between her symphysis pubis and the umbilicus. Although the abdomen is slightly distended, the bowel sounds are normal. No lymphadenopathy is detected, and the hernial sites are normal. Examination of the urologic genital skin reveals scattered crops of grouped, crusted, and pink vesicles in geometric configurations on the left buttock area (Figure 1).
A routine urine examination shows pyuria and hematuria with 11-20 white blood cells (WBCs) and 11-20 RBCs per high power field. A urine culture is performed, within 48 hours, and yields no bacterial colonization. Initial laboratory investigations including complete blood cell (CBC) count, liver function tests, kidney function tests, and electrolyte panel, as well as the coagulation profile are all normal.
A Foley’s catheter is then inserted with 2% lidocaine local anesthesia, from which 2000 cc of foul smell and discoloration urine are drained. During this admission, the serum Ig G of varicella-zoster virus > 5000 mIU/ml was found and the urodynamic study including cystometrygram (CMG) and sphincter electromyogram (EMG) were performed two week later which revealed patient’s bladder sensation (more than 400 ml during the storage phase), acontractile detrusor without urinary flow, and sphincter underactivity (Figure 2).