The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation

Abstract

ObjectiveThis study analyzed retrospectively the bladder function of patients after early surgery for cauda equina syndrome (CES) performed within 24 or 48 hours, or after 48 hours of the onset of autonomic symptoms.MethodsWe retrospectively reviewed the clinical data of 31 patients after decompression surgery for lumbar disc herniation (LDH) who had been diagnosed with CES between January 2001 and December 2014 at Inha University Hospital. The following factors were assessed to evaluate the influence of time to surgery: bladder function, rectal incontinence, sexual dysfunction, LDH level, and degree of spinal canal compression.ResultsAfter decompression, the outcome group was categorized into normal bladder function and abnormal bladder function. The patients operated on within 48 hours showed an improved postoperative outcome. Among 16 patients operated on within 48 hours, 13 (81%) recovered normal bladder function. In contrast, among 15 patients with decompression after 48 hours, 6 (40%) recovered normal bladder function. Among 21 patients with mild bladder dysfunction at admission, 16 (76%) recovered normal bladder function after decompression.ConclusionOur study suggests that patients who have decompression surgery within 48 hours of the onset of bladder dysfunction, improve their chances of recovering bladder function than those who have a late operation (>48 hours). Also, patients with mild bladder dysfunction are more likely to recover bladder function after decompression, than patients with severe bladder dysfunction.

Relationship between Preoperative Neuroradiological Findings and Intraoperative Bulbocavernosus Reflex Amplitude in Patients with Intradural Extramedullary Tumors

“…This result was similar to that of some reports on CE syndrome. 26,27) In contrast, this study showed that the preoperative compression rate for intradural extramedullary Epi-CM located at the lower end of the spinal cord was negatively correlated with intraoperative BCR amplitude. Therefore, in patients with intradural extramedullary Epi-CM lesions with strong compression, it is considered that the BCR amplitude is likely to be reduced even with careful surgical manipulation.…”

“… 26) In other reports of CE syndrome, no statistical relationship was observed between the degree of preoperative spinal canal compression and the prognosis of postoperative urinary symptom. 27) In this study, the preoperative compression rate was not correlated with the intraoperative BCR amplitude in the CE group with intradural extramedullary lesions. This result was similar to that of some reports on CE syndrome.…”