急性尿滯留與帶狀皰疹之探討：病例報告

Acute Urinary Retention Associated with Herpes Zoster : A Case Report

柯智裕(Jyh-Yuh Ke) ； 鍾佳英(Chia-Ying Chung) ； 鄧復旦(Fuk-Tan Tang) ； 趙明哲(Ming-Che Chao) ； 黃美涓(May-Kuan Wong)

《中華民國復健醫學會雜誌》 30卷2期 (2002/06) Pp. 111-115

摘要

帶狀皰疹引發神經性膀胱症而導致急性尿滯留是一種少見的併發症，此情形多半發生在病灶侵犯薦椎神經根時，不僅在該處皮節 （臀部及會陰附近） 出現帶狀皰疹，且併發膀胱或排便功能異常 （包括尿滯留、尿失禁、膀胱炎、便祕或大便失禁）。帶狀皰疹通常侵犯單側皮節，本文報告一位55歲男性患者，因帶狀皰疹侵犯兩側薦皮節 sacral dermatomes 2-4 （S2-S4） ，在明顯皮膚病灶出現二天前併發急性尿滯留病例，而排尿功能經過積極藥物及復健治療,在皮膚症狀出現一個月後恢復正常。帶狀皰疹併發排尿功能障礙的預後相當良好，大多數的病例在皮膚病灶癒後不久即可恢復正常的排尿功能，只有少數病例會導致永久的尿滯留。在治療上除了止痛、傷口照顧及處置疤痕外，必須早期發現是否有小便功能障礙，積極安排藥物及復健治療，避免因膀胱功能異常造成各種併發症或後遺症。

關鍵字

帶狀皰疹 ； 尿滯留 ； 神經性膀胱

並列摘要

Urinary retention is an uncommon complication of herpes zoster infection. It may happen secondary to a neurogenic bladder when the sacral dorsal root ganglia are involved. As a result, painful vesicular eruptions spreading over sacral dermatomes, such as buttock and perineum, may develop. Bladder and/or bowel dysfunction may occur as well, including urinary retention, constipation, and/or incontinence. The herpes zoster lesions usually have an unilateral dermatomal distribution. A 55-year-male patient with herpes zoster infection involving bilateral S2-S4 dermatomes is demonstrated. Acute urinary retention occurred 2 days before skin vesicular eruptions. His urine analysis revealed normal finding. Urodynamic study was taken and followed by intermittent catheterization program with oral bethanechol 25 mg four times a day. Urination became normal one month later after bladder dysfunction. The bladder dysfunction of most patients recovered completely after skin vesicular eruptions resolved, and only in some rare cases the urinary retention might persist permanently. As for treatment, in addition to pain relief and skin care, we should focus on early management of bladder dysfunction, to avoid the complication of bladder over-distention.

並列關鍵字

herpes zoster ； urinary retention ； neurogenic bladder