# Urinary Retention After AdVance™ XP Male Sling Placement Due to Herpes Zoster Virus Reactivation in the Immediate Postoperative Period: A Case Report

## TL;DR

A man developed urinary retention after a male sling surgery, linked to shingles reactivation, highlighting the need for careful preoperative risk assessment.

## Contribution

First reported case of VZV reactivation causing urinary retention after male sling placement.

## Key findings

- Surgical stress may trigger VZV reactivation leading to non-obstructive urinary retention.
- Conservative management with antiviral therapy resolved symptoms without needing sling revision.
- Preoperative vaccination and risk assessment could prevent such complications in at-risk patients.

## Abstract

Herpes zoster virus, commonly known as shingles, results from the reactivation of the latent varicella-zoster virus (VZV) in the sensory ganglia and typically presents as painful, unilateral eruptions following a dermatomal distribution. While reactivation is often associated with aging, stress, malignancy, or immunosuppression, urinary retention (UR) due to bladder atony is a less common complication, particularly when the lumbosacral ganglia are affected. We present the case of a 63-year-old male who developed acute UR (AUR) following an AdVance™ XP Male Sling (Boston Scientific, Marlborough, Massachusetts, US) procedure for stress urinary incontinence (SUI). A workup, including cystoscopy and post-void residual (PVR) measurement, confirmed non-obstructive UR. Within days, the patient developed vesicular skin lesions over the L2, L4, S1, and S3 dermatomes, consistent with VZV reactivation. A multidisciplinary approach was implemented, and conservative management with antiviral therapy and catheterization led to complete symptom resolution. This is the first reported case of VZV reactivation following male sling placement, suggesting that surgical stress may be a trigger. Clinicians should recognize atypical VZV presentations, including UR, and prioritize conservative management before considering sling revision. Preoperative risk assessment, including vaccination for at-risk patients, may help prevent complications in future cases.