Reassessing Bladder Recovery in Cauda Equina Syndrome: Long-Term Outcomes After Surgical Decompression - A Systematic
Elie Najjar1, Rodrigo Muscogliati2, Charlie Trumble3
1Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
Summary
Cauda equina syndrome (CES) surgery often results in persistent bladder dysfunction in about one-third of patients. Urinary retention before surgery is a key factor influencing long-term bladder outcomes.
Area of Science:
- Neurosurgery
- Urology
- Spinal Surgery
Background:
- Bladder dysfunction is a significant complication of cauda equina syndrome (CES), impacting long-term patient disability.
- Current data on recovery rates and the prevalence of persistent bladder issues after surgical decompression are inconsistent.
Purpose of the Study:
- To determine long-term bladder outcomes after surgical decompression for CES caused by degenerative spine conditions.
- To quantify the prevalence of persistent bladder dysfunction in these patients.
Main Methods:
- A systematic review and meta-analysis of observational studies adhering to PRISMA guidelines.
- Searched MEDLINE, Embase, and PubMed for studies with a minimum 12-month follow-up.
- Included patients with CES secondary to degenerative lumbar spine disease undergoing surgical decompression.
Main Results:
- Sixteen studies involving 987 patients were analyzed.
- The pooled prevalence of persistent bladder dysfunction at long-term follow-up was 32.6%.
- Patients with preoperative urinary retention showed poorer outcomes, with a crude persistent dysfunction rate of 46.8%.
Conclusions:
- Approximately one-third of patients experience persistent bladder dysfunction post-decompression for degenerative CES.
- Preoperative urinary retention is a significant indicator of poorer long-term bladder outcomes.
- Further standardized research is needed for better prognostic stratification and patient counseling.