Immersive Translation

One Case of Deep Electroacupuncture Treatment for Postherpetic Urinary Retention in Elderly Women

Background

Urinary retention is a rare complication of herpes zoster (herpes zoster, HZ), caused by the varicella-zoster virus (VZV) attacking the lumbar-sacral nervous system, and is primarily manifested as urinary retention. It may be accompanied by a series of clinical syndromes including radiating pain, sensory abnormalities, and weakness in the lower limbs due to radicular symptoms. Although the incidence of post-herpetic urinary retention in adults and middle-aged individuals is less than 1.2/1,000,000 ² , the neuralgia and urinary disorders it causes can severely affect the quality of life, sleep quality, and the ability to participate in daily activities. Unfortunately, there are very limited treatment options for this disease in clinical practice; antiviral drugs, corticosteroids, and antibiotics are commonly used treatment measures, but their efficacy is not satisfactory ³ . Therefore, seeking a safe and effective complementary or alternative therapy is of great significance.

Acupuncture, as a traditional Chinese external treatment method, is widely used for its simple operation and few side effects in the treatment of pain and neurological functional system diseases ⁴ . However, there are still relatively few reports on the efficacy of acupuncture treatment for urinary retention caused by herpes zoster. Here, we describe a case of a geriatric female patient with post-herpetic urinary retention who, after one month of conventional drug treatment proved ineffective, successfully removed the catheter and recovered the function of spontaneous urination after 10 days of standardized electroacupuncture treatment. Follow-up for 3 months showed no recurrence.

Case presentation

An 83-year-old female patient presented with left lumbar-sacral skin hyperalgesia and pain on February 20, 2024. She developed pinpoint pink blisters around the perianal area, on the inner side of the left thigh, and on the ankle. After seeking medical attention at a local hospital, she was diagnosed with herpes zoster and was prescribed oral mecobalamin tablets and prednisone acetate. On February 29th, she suddenly experienced difficulty urinating and went to the hospital again. The bladder residual urine volume was measured to be approximately 1074ml after urination, and she was diagnosed with "post-herpetic urinary retention." She was then treated with medication and intermittent catheterization. After one month of treatment, her symptoms did not improve significantly, and she still had difficulty urinating. On March 26th, she came seeking acupuncture treatment while still wearing a catheter.

Electroacupuncture treatment

The patient assumes a prone position, disinfects the skin with 75% alcohol, and uses Hwato brand disposable acupuncture needles produced by Suzhou Medical Supplies Co., Ltd. for acupuncture at the traditional acupoints along the Du Meridian, the Bladder Meridian (both sides), the Huatuo Shuji points (both sides), and the Spleen Meridian (both sides). The needles and acupuncture techniques are selected according to the acupoints (Table 1).

Table 1: Acupuncture Points and Techniques
Channel or Meridian Associated	Acupuncture Point Names	Acupuncture Needle Specifications	Acupuncture Depth and Angle
Governor Vessel	DU1 (Changqiang)	0.35mm × 75mm	60-75mm (upward, needle entry angle of 5°~10°)
		DU14 (Da Chi Point)	0.35mm × 40mm	10-15 mm (needle inserted vertically)
		DU20 (Baihui)	0.35mm × 40mm	10-15 mm (forward, angle 5°~10°)
Bladder Meridian (Both Sides)	BL32 (Acupoint: Lower Brightness)	0.35mm × 40mm	10-15 mm (needle inserted vertically)
Bladder Meridian (Both Sides)		BL54 (Ranking Edge)	0.35mm × 75mm	60-75mm (towards the inside, needle angle of 70° to 75°)
Spleen Meridian (Both Sides)	SP6 (San Yin Jiao)	0.35mm × 40mm	10-15 mm (needle inserted vertically)
Huatojiaji (Both Sides)	L3-S1	0.35mm × 40mm	0-15 mm (towards the inside, needle entry angle 45°)

Special attention should be paid to the needle angles: DU1 and DU20 are inserted at an angle of 5° to 10° upwards and forwards, BL54 at an angle of 70° to 75° towards the inside, and EX-B2 at an angle of 45° towards the inside. All other needles are inserted vertically. After insertion, minor rotations and lifting-insertion techniques are performed on all needles at a low frequency to achieve the "Deqi" (a comprehensive sensation including pain, numbness, swelling, heaviness, and other sensations), which is considered an important factor in the efficacy of acupuncture.

After achieving the Qi in acupuncture, a pair of electrodes from the electric acupuncture device is connected horizontally to the needles at EX-B2 and BL32. The electric acupuncture stimulation lasts for 30 minutes, with a continuous wave at 50 Hz and an intensity of 1 to 5 mA (the doctor observes or the patient feels a slight tremble around the acupoint skin, with no pain felt by the patient). Each acupuncture session lasts for 30 minutes, with one session per day, for a continuous treatment of 10 days. A follow-up examination is conducted one week after discharge, and a follow-up visit is scheduled three months after discharge. All acupuncture procedures are performed by an experienced acupuncturist registered in China.

Clinical outcome

After the first session of electroacupuncture treatment, the catheter was removed and the patient spontaneously voided 660ml of urine. Subsequently, over the next few hours, the patient repeatedly voided 200-300ml of urine. However, after 9 p.m., the patient was unable to void spontaneously again, and the urologist assessed that the catheter should be reinserted. After admission, the patient underwent a full abdominal CT scan and urodynamic examination, and after expert consultation, the diagnosis was "neurogenic bladder and urethral dysfunction." The acupuncturist continued with electroacupuncture treatment for 7 more sessions. After the treatment, the patient's residual urine volume was measured at 80-100ml. On the 9th day, the catheter was removed, and the patient was able to void spontaneously. On the 10th day, the residual urine volume was 80ml, and the urine leukocyte and erythrocyte tests returned to normal. No bacteria were found in the bacterial culture. After the electroacupuncture treatment, the patient was discharged. One week after discharge, the residual urine volume was rechecked at 80ml, and the patient was able to void autonomously without any treatment. Three months later, during the follow-up phone call, the patient reported that there had been no recurrence of the condition and that they had returned to normal life. Table 2 describes the patient's improvement process and related examinations, and Figure 1 shows the changes in the patient's urinary tract ultrasound before and after treatment.

Table 2: Patient Condition and Relevant Examinations

Date	Relevant inspections	Brief Medical Description
Day 1	Ultrasound examination shows: The bladder is adequately filled, and an echo of the catheter is visible within the bladder. The size of the bladder neck is 14mm x 14mm.	After acupuncture treatment, the patient reported a feeling of bladder fullness. After the catheter was removed and multiple spontaneous urinations occurred, the patient complained of difficulty urinating again that evening. A catheter was reinserted, and the urine output reached 1080ml.
Day Two	The whole abdominal CT scan shows thickening of the bladder wall, with no signs of bladder outlet obstruction or other abnormal findings; the urine routine analysis shows 648 uL of leukocytes and 59.3 uL of red blood cells.	The patient retains a urinary catheter, closes the catheter switch, and opens and closes the catheter every two hours. Each time, 800ml of urine is released before the catheter is closed again.
Day Three	The synchronous measurement of pressure and flow rate shows that the bladder's functional capacity is normal, with poor sensory function, high compliance, and unstable detrusor muscle during the storage phase Dilation of the bladder, with weak detrusor contraction during micturition.	The patient retains a urinary catheter, and the method of clamping during the day is adjusted to open the catheter valve only when the patient feels a significant bladder fullness, with each release of urine being 1000ml and then closing the valve; at night, starting at 22:00 when the patient falls asleep, the catheter is kept closed until the next morning when the patient wakes up with a sense of bladder fullness and then the valve is opened.
Day Six	\	The patient retains a catheter and feels a bladder fullness every three hours or so, releasing urine of approximately 800-1000ml each time. At night, they do not wake up due to the sensation of bladder fullness.
Day 8	\	The patient retains a catheter, feeling a significant fullness in the bladder, with pale yellow urine, releasing 800-1000ml of urine each time, and sleeping normally.
Day Nine	\	After evaluation by the urologist, the catheter was removed. The patient was able to urinate independently, with each urination amounting to approximately 800ml, and there were no discomfort symptoms.
Day Ten	Ultrasonic examination shows: 18ml of residual urine after urination, urine routine analysis: white blood cells 7.5 uL, red blood cells 17.2 uL.	The patient is able to urinate independently, has no lower urinary tract infection, and exhibits no discomfort symptoms. Discharge from the hospital.
Post-discharge follow-up visit after one week	Ultrasonic examination shows: Residual urine volume 80 mL	The patient is able to urinate independently and has no other discomfort
Post-discharge follow-up after three months	无	Phone Follow-up Achieves Autonomous Urination, Returns to Normal Life

Figure:

On February 29, 2024, the ultrasound examination revealed a residual urine volume of 1074 milliliters.

On March 26, 2024, the bladder was full, and an echo of the catheter was visible inside. The size of the bladder neck was 14mm x 14mm. On April 4, 2024, the ultrasound showed a residual urine volume of 18 mL.

Comment

Through this case, we emphasized the potential efficacy of acupuncture in treating postherpetic urinary retention. Previous studies have confirmed the positive therapeutic effects of acupuncture on various types of urinary retention, including puerperal urinary retention ⁵ , post-spinal anesthesia urinary retention ⁶ , postoperative urinary retention ⁷ , and post-stroke urinary retention ⁸ . The efficacy of acupuncture in treating herpes zoster has also been verified by related research ⁹ . Electroacupuncture at the Jiaji points located at the dorsal root of the spinal cord invaded by the herpesvirus can quickly and effectively alleviate the symptoms of herpes zoster, significantly reduce pain, and shorten the course of the disease. This efficacy is related to the electroacupuncture's ability to enhance the body's immunity, inhibit autophagy of herpes zoster neuron cells, promote the growth of nerve cells, and reduce nerve damage ¹⁰ . However, clinical cases with both symptoms still remain relatively rare. The pathogenesis of postherpetic urinary retention is complex, and there is no definitive conclusion, which presents a challenge for its treatment. The varicella-zoster virus (VZV) causes chickenpox during primary infection and then 潜伏于 spinal dorsal root ganglia, and is reactivated and causes herpes zoster with factors such as aging, immune suppression, and stress ¹¹ . When the virus invades and activates the L3-S2 spinal sacral dorsal root ganglion, nerve roots, and peripheral nerves, it can cause sacral lumbosacral plexopathy, including dysfunction of the detrusor muscle, bladder internal sphincter, and urethral sphincter, leading to urinary retention ¹² . In this case, we significantly improved the patient's difficulty in urination through electroacupuncture treatment, and there were no recurrence phenomena observed during the follow-up period of 3 months. Currently, the mechanism of electroacupuncture in the prevention and treatment of urinary retention has not been definitively established, but there is research showing that electroacupuncture can improve bladder dysfunction in neurogenic urinary retention by promoting detrusor excitability and activating the urinary electrical signal pathway ¹³ . In addition, electroacupuncture can also reduce the concentration of adenosine triphosphate (ATP) in urine, accelerate the recovery of spontaneous urination, and protect the normal physiological function of the bladder ¹⁴ .

Summary

Our clinical observations suggest that electroacupuncture therapy may be a promising potential treatment for urinary retention caused by herpes zoster, although this is a case report lacking objective evidence to support it. We hope that the findings of this case study will inspire subsequent researchers to further explore acupuncture as a potential treatment for post-herpes zoster urinary retention, and to conduct a large-scale prospective randomized controlled trial to confirm its efficacy. Additionally, we should apply modern scientific and technological methods to multidisciplinary research to explore its potential mechanisms of action.

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