Acute urinary retention due to benign inflammatory nervous diseases

Abstract

Both neurologists and urologists might encounter patients with acute urinary retention due to benign inflammatory nervous diseases. Based on the mechanism of urinary retention, these disorders can be divided into two subgroups: disorders of the peripheral nervous system (e.g., sacral herpes) or the central nervous system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities include increased herpes virus titers in sacral herpes, and increased myelin basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic abnormality in both conditions is detrusor areflexia; the putative mechanism of it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal shock in MRS. There are few cases with CSF abnormality alone. Although these cases have a benign course, management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. Clinical features of sacral herpes or MRS differ markedly from those of the original "Elsberg syndrome" cases.

Meningitis-retention Syndrome: First Case of Urodynamic Follow-up

“…Sakakibara et al referred to this peculiar combination as meningitisretention syndrome (MRS), since patients with MRS exhibit no other abnormalities, other than mild pyramidal involvement (1,2). Conversely, because of the presence of mild pyramidal involvement (suggesting spinal cord involvement) and increased myelin basic protein in the cerebrospinal fluid (CSF) (suggesting demyelination), MRS is considered to be a very mild form of acute disseminated encephalomyelitis (ADEM).…”

“…MRS has a benign and self-remitting course. Therefore, the responsible site of lesions for urinary retention in MRS remains obscure (2), except for areflexic detrusor at the time of urinary retention. Recently, we encountered a man with MRS in whom a urodynamic study was performed twice.…”

Acute Urinary Retention due to Aseptic Meningitis: Meningitis-Retention Syndrome

“…Aseptic meningitis is a common neurological disorder, but it is not commonly known that acute urinary retention can accompany aseptic meningitis as a symptom or complication. Like this case, with no other cause of acute urinary retention, the occurrence of acute urinary retention together with aseptic meningitis is called meningitis-retention syndrome [3].…”

“…These nervous diseases can be divided into peripheral nervous diseases, such as sacral herpes, and central nervous diseases, such as meningitis-retention syndrome [2]. The latter can be defined as the co-occurrence of aseptic meningitis and acute urinary retention without any other disease that might cause urinary retention [3]. However, the typical symptoms and neurological signs of aseptic meningitis are occasionally mild or even absent, and the condition can be difficult to diagnose early.…”

Herbal Medicine-induced Meningitis-retention Syndrome

“…However, it can cause some adverse events: e.g., pseudoaldosteronism due to Licorice (Glycyrrhiza, Kanzou) (1) or hepatitis/pneumonitis due to Bupleurum (Saiko) (2), etc. Here, we report for the first time a case in which herbal medicines (Shinbu-Tou and Rikkunshi-Tou) induced meningitis-retention syndrome (MRS) (3,4), dermatitis, and latent pneumonitis in an elderly woman.…”