Bladder Recovery Patterns in Patients with Complete Cauda Equina Syndrome: A Single-Center Study

Area of Science:

• Neurosurgery
• Urology
• Spinal Surgery

Background:

• Cauda equina syndrome (CES) often results from lumbar disc herniation (LDH) or lumbar canal stenosis (LCS).
• Prognostic factors for bladder recovery in CES are not well-defined, and a clinical classification for bladder recovery is lacking.
• Existing literature offers limited data on meaningful bladder recovery status classifications for clinical use.

Purpose of the Study:

• To identify factors influencing bladder recovery in patients with CES.
• To propose a simplified classification system for bladder recovery in CES.
• To assess the correlation between patient variables and bladder function outcomes.

Main Methods:

• A retrospective case series of 39 patients with CES secondary to LDH or LCS was conducted over three years.
• Data collected included demographics, symptom duration, neurological and bladder symptoms, and surgery duration.
• Bladder function outcomes were assessed at discharge and during a minimum two-year follow-up period.

Main Results:

• Perianal sensation (PAS) was the sole significant predictor of neurological recovery and subsequent bladder function recovery.
• In cases with absent PAS, bladder function did not recover.
• Voluntary anal contraction (VAC) was impaired in all patients, with decreased or absent VAC being a sensitive marker for CES.

Conclusions:

• Intact perianal sensation is the most significant prognostic indicator for bladder recovery in CES.
• Assessing voluntary anal contraction is critical for diagnosing CES.
• A simplified bladder recovery classification was proposed to aid in prognosis.