Overview
Cauda equina syndrome (CES) is a surgical emergency characterized by compression of the nerve roots of the cauda equina, leading to potential permanent neurological deficits. Symptoms can include severe low back pain, saddle anesthesia, bowel or bladder dysfunction, and lower extremity weakness or sensory loss.Diagnosis
Clinical evaluation should encompass medical history (general and focused) and physical examination 1.
Urinalysis is recommended 1.
Bladder ultrasound with post-void residual measurement and a voiding diary may be crucial supplementary diagnostic measures 1.
Further investigations such as endoscopy, imaging (other than bladder ultrasound), cytology, and urodynamics may be necessary if urinary urgency is accompanied by hematuria, pelvic mass, voiding symptoms, pelvic pain, neurological diseases, or other conditions affecting the urinary tract 1.Management
If other causes of symptoms are excluded, diagnosis of overactive bladder (OAB) is established and pharmacotherapy may be initiated 1.Key Recommendations
Clinical evaluation of patients with symptoms suggestive of overactive bladder syndrome should encompass medical history, physical examination, and urinalysis 1. (Evidence: Expert opinion)
Bladder ultrasound with assessment of post-void residual measurement, as well as a voiding diary, might be crucial supplementary diagnostic measures for overactive bladder syndrome 1. (Evidence: Expert opinion)
If initial evaluations exclude other causes, pharmacotherapy may be initiated for overactive bladder syndrome 1. (Evidence: Expert opinion)References
1 Dybowski B, Narojczyk-Swiesciak E, Baranowski W, Rechberger T, Miotla P, Futyma K et al.. The Urogynecology Section of the Polish Society of Gynecologists and Obstetricians Guideline on the diagnostic management of non-neurogenic overactive bladder syndrome in women. Ginekologia polska 2025. link