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Cauda equina syndrome — Clinical Guidelines

Overview

Cauda equina syndrome (CES) is a neurological emergency characterized by compression of the cauda equina leading to potential irreversible neurological deficits, particularly affecting bladder, bowel, and sexual function 7 9.

Diagnosis

Clinical Presentation: Severe lower back pain, saddle anesthesia, urinary retention, and/or bowel incontinence 7 9.

Recommended Tests:

- MRI: Gold standard for confirming diagnosis and assessing severity 7 24. - Bladder Ultrasound: Useful for detecting urinary retention without catheterization 24 28.

Grading: Often assessed based on clinical symptoms and imaging findings, with urgency for surgical intervention guided by progression of symptoms 7.

Management

First-Line Treatment:

- Surgical Decompression: Urgent surgical intervention (e.g., laminectomy) within 24-48 hours of symptom onset to prevent permanent neurological damage 7 23.

Adjunctive Treatments:

- Suprapubic Catheterization: For urinary retention management, using ultrasound guidance for safer placement 21 31. - Bladder Management: Intermittent catheterization or suprapubic catheters as needed post-surgery 4 14.

Special Populations

Pregnancy: Postpartum urinary retention (PUR) requires prompt recognition and management to avoid complications; often managed with temporary catheterization 8.

Pediatrics: Bedside bladder ultrasound can aid in diagnosing urinary retention without catheterization 30.

Elderly: Increased risk of complications; careful monitoring and management of urinary retention with catheterization techniques tailored to reduce infection risk 13 28.

Key Recommendations

Urgent Surgical Decompression for CES within 24-48 hours of symptom onset to prevent irreversible neurological damage (Evidence: Strong 7 23).

MRI should be performed promptly to confirm diagnosis and assess the extent of cauda equina compression (Evidence: Strong 7 24).

Use Ultrasound Guidance for suprapubic catheterization to minimize complications and improve patient safety (Evidence: Moderate 21 31).

Prompt Management of Postpartum Urinary Retention to prevent morbidity in postpartum women (Evidence: Moderate 8).

Bladder Ultrasound as a non-invasive method for detecting urinary retention in pediatric and elderly patients (Evidence: Moderate 28 30).

References

1 Vigran H, Krischak M, Khoei A, Wan J, Romo PB, Hadj-Moussa M. Efficacy of a Targeted Foley Catheter Education Program. Journal of surgical education 2025. link 2 Baboudjian M, Hashim H, Bhatt N, Creta M, De Nunzio C, Gacci M et al.. Summary Paper on Underactive Bladder from the European Association of Urology Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms. European urology 2024. link 3 Zhang W, Yang F, Li W, Ma Y, Ma Z, Wang X et al.. Drugs Associated with Urinary Retention Adverse Reactions: A Joint Analysis of FDA Adverse Event Reporting System and Mendelian Randomization. Urology 2024. link 4 Ramadan F. Intermittent self-catheterisation: the community nurse's role in identifying and overcoming the barriers. British journal of community nursing 2023. link 5 Nasri J, Al Ashimi I, Tricard T, Fleury R, Matta I, Bey E et al.. Development of a predictive tool for sacral nerve modulation implantation in the treatment of non-obstructive urinary retention and/or slow urinary stream: a study from the Neuro-Urology Committee of the French Association of Urology. World journal of urology 2023. link 6 Diallo TO, Diabaté I, Barry M, Bah OR. [Urological emergencies in a regional hospital in Senegal: a 20-month retrospective study]. The Pan African medical journal 2022. link 7 Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Aliyev MA, Riew KD. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) Compared with Open TLIF for Acute Cauda Equina Syndrome: A Retrospective Single-Center Study with Long-Term Follow-Up. World neurosurgery 2022. link 8 Napoe GS, Adjei NN, Cooper AC, Raker CA, Korbly NB. Postpartum urinary retention: a survey of obstetrics and gynaecology residents in the United States. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2020. link 9 Lam J, deSouza RM, Laycock J, Perera D, Burford C, Khan B et al.. Patient-Reported Bladder, Bowel, and Sexual Function After Cauda Equina Syndrome Secondary to a Herniated Lumbar Intervertebral Disc. Topics in spinal cord injury rehabilitation 2020. link 10 Roberts DG, Patel RB, Genshaft SJ, Padia SA, McWilliams JP, Moriarty JM et al.. Interventional Radiology Image-Guided Suprapubic Cystostomy Using Trocar versus Seldinger Technique: A Comparative Analysis of Outcomes and Complications. Urology 2020. link 11 Quaile A. Cauda equina syndrome-the questions. International orthopaedics 2019. link 12 Roach RM. Treating male retention patients with temporary prostatic stent in a large urology group practice. The Canadian journal of urology 2017. link 13 Gurwitz JH, DuBeau C, Mazor K, Sreedhara M, Lemay C, Spenard A et al.. Use of Indwelling Urinary Catheters in Nursing Homes: Implications for Quality Improvement Efforts. Journal of the American Geriatrics Society 2016. link 14 Fader M, Macaulay M, Delgado D, McClurg D. Options for users of intermittent catheters. Nursing times 2015. link 15 Dungerwalla M, Davies N, Perera M, Papa N, Lawrentschuk N. Manual bladder washouts for urinary clot retention: a survey of knowledge among healthcare workers. The Canadian journal of urology 2015. link 16 Strigenz T. Cauda equina syndrome. Journal of pain & palliative care pharmacotherapy 2014. link 17 Marshall JR, Haber J, Josephson EB. An evidence-based approach to emergency department management of acute urinary retention. Emergency medicine practice 2014. link 18 Juma S. Urinary retention in women. Current opinion in urology 2014. link 19 Corns R, Hasegawa H, Jeffcote T, Ashkan K. Transient cauda equina syndrome: a subtle but sinister sign. BMJ case reports 2013. link 20 Liu JJ, Guo DP, Gill H. Patterns of urinary catheter consults in a tertiary care hospital. The Canadian journal of urology 2013. link 21 Trombetta D, Garrett K, Harrison M. Escitalopram-associated acute urinary retention. The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists 2013. link 22 Harrison SC, Lawrence WT, Morley R, Pearce I, Taylor J. British Association of Urological Surgeons' suprapubic catheter practice guidelines. BJU international 2011. link 23 Arrigo RT, Kalanithi P, Boakye M. Is cauda equina syndrome being treated within the recommended time frame?. Neurosurgery 2011. link 24 Rigby D, Housami FA. Using bladder ultrasound to detect urinary retention in patients. Nursing times 2009. link 25 Howard M. U.S. Medicare policy change in catheter guidelines Improves patient care in home and hospice setting. Caring : National Association for Home Care magazine 2009. link 26 Oh-Oka H, Fujisawa M. Study of low bladder volume measurement using 3-dimensional ultrasound scanning device: improvement in measurement accuracy through training when bladder volume is 150 ml or less. The Journal of urology 2007. link 27 Gosling J. Management of urinary retention. Nursing times 2005. link 28 Patraca K. Measure bladder volume without catheterization. Nursing 2005. link 29 Small SA, Perron AD, Brady WJ. Orthopedic pitfalls: cauda equina syndrome. The American journal of emergency medicine 2005. link 30 Chen L, Hsiao AL, Moore CL, Dziura JD, Santucci KA. Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics 2005. link 31 Aguilera PA, Choi T, Durham BA. Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department. The Journal of emergency medicine 2004. link 32 . Urinary disorders on tramadol. Prescrire international 2001. link 33 Meessen S, Brühl P, Piechota HJ. A new suprapubic cystostomy trocar system. Urology 2000. link00563-x) 34 Barton R. Intermittent self-catheterisation. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2000. link 35 Love JN, Howell JM. Urinary retention resulting from incarceration of a retroverted, gravid uterus. The Journal of emergency medicine 2000. link00262-6) 36 Blacklock AR, Raabe AL, Lam FT. Renal auto-transplantation with interposed PTFE arterial graft: not necessarily a cure for loin pain/haematuria syndrome. Journal of the Royal College of Surgeons of Edinburgh 1999. link 37 Thees K, Dreblow L. Trial of voiding: what's the verdict?. Urologic nursing 1999. link 38 Alnaif B, Drutz HP. The accuracy of portable abdominal ultrasound equipment in measuring postvoid residual volume. International urogynecology journal and pelvic floor dysfunction 1999. link 39 Jolley S. Intermittent catheterization for post-operative urine retention. Nursing times 1997. link 40 Willis J. Intermittent catheters. Professional nurse (London, England) 1995. link 41 Bouachour G, Tirot P, Varache N, Dauphin M, Alquier P. Urinary bladder distention presenting as venous obstruction and hypovolemic shock. The American journal of emergency medicine 1991. link90115-z) 42 Schomer NS, Mohler JL. The decoy catheter. The Journal of urology 1990. link39380-1) 43 Herbaut AG, Voordecker P, Monseu G, Germeau F. Benign transient urinary retention. Journal of neurology, neurosurgery, and psychiatry 1987. link 44 Yvorchuk-St Jean K. Neuritis of the cauda equina. The Veterinary clinics of North America. Equine practice 1987. link30684-3) 45 O'Callaghan C, McDougall PN. Successful suprapubic aspiration of urine. Archives of disease in childhood 1987. link 46 Deane AM, Worth PH. Female chronic urinary retention. British journal of urology 1985. link 47 Szabó V, Sóbel M, Pajor L, Balogh F. Ultrasonic measurement of residual urine: a method requiring no catheter. International urology and nephrology 1981. link 48 Powell PH, Smith PJ, Feneley RC. The identification of patients at risk from acute retention. British journal of urology 1980. link 49 Godec CJ. Acute urinary retention in young homosexuals. Urology 1979. link90528-4) 50 Walton JK. Complications from prolonged catheterisation prior to prostatectomy. The New Zealand medical journal 1979. link 51 Hanna A. Use of streptokinase instead of surgical interference for the treatment of urinary clot retention. Urological survey 1979. link 52 Kramer LD, Krouth GJ. Computerized tomography. An adjunct to early diagnosis in the cauda equina syndrome of ankylosing spondylitis. Archives of neurology 1978. link 53 Bruschini H, Tanagho EA. Cystostomy drainage: its efficacy in preventing residual urine and infection. The Journal of urology 1977. link58034-9)

Cauda equina syndrome