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Urinary dysfunction in spinal meningiomas: a significant disease severity marker in a cohort of 165 patients
Lorenzo Aureli1, Mauro Palmieri2, Alexandro Paccapelo3
1Systems Medicine Department - Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy. lorenzo.aureli@ptvonline.it.
Background:
Spinal meningiomas (SM) are generally benign tumours with favourable surgical outcomes. However, their potential to impair sphincter function-particularly bladder control-remains insufficiently investigated. Bladder dysfunction, ranging from urge incontinence to complete urinary incontinence, may significantly impair quality of life and correlate with both neurological status and surgical outcomes.
Objective:
This study aimed to determine whether preoperative clinically reported urinary impairment is associated with disease severity in surgically treated spinal meningiomas. Secondary aims were to evaluate its relationship with symptom duration, neurological status, extent of resection, and follow-up functional outcome.
Methods:
From a multicentric cohort of 270 SM operated between 1976 and 2023, 165 cases were retrospectively analysed. Patients were stratified according to preoperative patient-reported urinary status. Neurological function was assessed using Frankel and McCormick scales, while extent of resection was classified according to Simpson grade. Associations were explored using group comparisons and Spearman correlation. Univariable and multivariable logistic regression analyses were performed to identify factors associated with urinary dysfunction. Model discrimination was assessed using ROC analysis, and an exploratory nomogram was generated from the final multivariable model.
Results:
Symptom duration was longer in patients with sphincter impairment (p < 0.001). Extent of resection differed between groups (p = 0.007). Neurological status was worse both preoperatively and at follow-up, as reflected by Frankel (p = 0.009 preoperatively; p = 0.018 at follow-up) and McCormick grades (p = 0.010 both preoperatively and at follow-up).
Conclusion:
Patient-reported urinary dysfunction was associated with longer symptom duration and worse neurological status in spinal meningiomas, underlining its role as a clinically relevant marker of disease severity. These findings should be interpreted as associative rather than causal, and prospective studies with standardized neuro-urological assessment are required.
