Acute Urinary Retention: A Unique Complication of Primary Varicella Infection of Childhood

Abstract

An 8-year-old boy presented with acute urinary retention 1 week after the onset of a classical primary varicella (chickenpox) rash. Examination confirmed a bladder palpable at the umbilicus. The prepuce was oedematous with a large vesicle on the glans penis obscuring the urethral meatus (Fig. 1).Under general anaesthesia the vesicle was incised and drained. Passage of a urethral catheter was precluded by meatal induration; a 16F suprapubic catheter was therefore inserted (Fig. 2). Following removal of the suprapubic catheter the urethral urinary stream was Fig. 2 Suprapubic catheter in situ. Chickenpox vesicle can be seen on the abdominal wall.unsatisfactory but was restored following dilatation of a meatal stricture. A rising antibody titre confirmed varicella-zoster infection. CommentPrimary exposure to the varicella-zoster virus usually produces systemic disturbance accompanied by widespread crops of vesicles (chickenpox). Herpes zoster (shingles) represents a reactivation of the virus in the dorsal root ganglion, producing the typical vesicular eruption in the corresponding sensory dermatome. Involvement of the sacral plexus resulting in urinary retention is well documented in shingles (Davidsohn, 1890; Rankin and Sutton, 1969;Richmond, 1974). However, we report acute urinary retention as a complication of chickenpox, an association which has not been reported previously.The precise cause of the acute urinary retention in our patient is unclear. However, it is possible that the following factors were involved: the neurogenic effect of primary varicella infection on the sacral plexus; the mechanical effect of the vesicle and associated induration occluding the Fig. 1 Vesicle on glans penis with local oedema and induration.546 CASE REPORTS 547 external urethral meatus; the discomfort experienced when attempting micturition. Acknowledgement