Urodynamic findings with disc protrusion

Urodynamic evaluation of surgical outcome in patients with urinary retention due to central lumbar disc prolapse

“…This ¢nding is consistent with many other reports: patients could void by abdominal straining without detrusor contraction [Scott, 1965;Fanciullacci, 1994;Bartolin et al, 1999;Goldman and Appell, 1999;Nesathurai and Jessiman, 1999]. The relief of pain may be the reason why they could gain micturition posture (standing, sitting, or even bending-forward position).…”

“…Previously, we reported a considerable variation in £ow rate, and the greatest £ow rate was obtained in a prone or bending-forward position in normal volunteers [Yamanishi et al, 1999a]. Additional use of alpha-blockers may be e¡ective in obtaining a balanced bladder even in patients with acontractile detrusor [Fanciullacci, 1994;Yamanishi et al, 1999b;Orendacova et al, 2001]. …”

“…Bartolin et al [1998Bartolin et al [ , 1999 reported unchanged bladder function after surgery in patients with acontractile detrusor in lumbar disc prolapse, although they excluded patients with cauda equina syndrome due to central disc prolapse. Fanciullacci [1994] has reported that acontractile detrusor with normal compliance and severe denervation of the pelvic £oor are the most frequent urodynamic pictures in lumbar disc central protrusion preoperatively. At follow-up, 65% of his patients still had acontractile detrusor but 10 of 17 recovered electromyographic activity in the pelvic £oor, indicating that detrusor function was irreversible whereas urethral function showed a better recovery.…”

“…Clinical features of the cauda equina syndrome include low-back pain, bilateral sciatica, saddle anesthesia, and urinary retention [O'Flynn et al, 1992;Wetzel, 1996;Kennedy et al, 1999;Ahn et al, 2000;Orendacova et al, 2001]. Central lumbar protrusion involves nerve ¢bers to and from the bladder, the large bowel, the anal and urethral sphincters, and the perineal £oor [Fanciullacci, 1994]. Thus, central lumbar disc prolapse results in sacral nerve root compression and urinary retention and is a true surgical emergency [Jennett, 1956;Nielsen et al, 1980;Wetzel, 1996].…”

Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies

“…However, the definition of CESI is itself extremely cloudy in the literature-there are numerous studies that demonstrate bladder involvement without full-blown CES in cases of disc herniation and/or spinal stenosis, and there is no indication in the literature concerning which, if any, of these patients might have progressed to full-blown CES had they been left unattended. [8][9][10][11]28,39,40,43,44,53,68,77,84,95,105,116,[125][126][127][128]143,159,163 We attempted to follow the advice of Gleave and Macfarlane and perform meta-analyses only on those studies in which we could, with reasonable confidence, separate cases of CESR and CESI (or more exactly "non-CESR").…”